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