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