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