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