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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
T
V
M
B
I
H
B
C
K
R
R
U
J
G
P
J
P
N
Y
I
U
X
D
B
T
B
S
L
R
M
B
R
Z
J
B
S
O
E
A
U
O
B
E
K
N
T
U
C
G
C
B
I
A
D
D
U
W
W
N
R
E
S
W
C
I
D
V
E
U
T
A
I
E
C
I
V
J
E
L
T
A
H
A
B
L
A
O
G
C
E
R
A
C
I
D
E
M
R
J
V
E
R
U
D
E
C
O
R
P
P
U
S
I
S
O
N
G
A
I
D
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