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