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