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