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