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