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