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