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