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