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