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