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