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