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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
Z
R
D
F
P
G
E
P
D
K
U
Z
S
Z
P
L
L
C
E
I
H
Y
B
S
E
T
R
E
A
E
A
M
F
R
S
C
G
T
Q
L
R
G
T
E
K
E
C
A
R
K
P
U
N
L
X
D
O
D
R
V
A
V
D
O
T
W
B
I
J
I
I
V
H
E
S
U
G
E
J
C
X
V
B
H
C
I
I
B
F
Z
X
A
S
O
E
O
S
V
D
G
K
L
V
R
O
R
R
E
T
Y
P
U
P
O
F
E
F
P
X
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