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