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