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Miscellaneous: Claims Adjustments
Claims
Claims Adjustments
Claims
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CHARGES
COB
DATE
DIAGNOSIS
MEDICARE
PLACE
PROCEDURE
PROVIDER
SUBSCRIBER
S
Z
D
I
A
G
N
O
S
I
S
O
U
C
H
A
R
G
E
S
U
M
W
U
B
E
R
A
C
I
D
E
M
I
B
R
S
L
B
C
X
V
R
Y
D
D
Z
E
C
X
W
P
O
U
I
Y
H
L
O
D
R
E
T
A
D
N
M
F
B
I
B
I
I
F
O
E
S
Y
L
P
F
N
J
V
B
N
C
S
H
D
X
B
B
J
K
O
E
O
U
P
B
E
A
F
Y
X
Q
R
R
S
H
G
P
J
I
E
C
A
L
P
K
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