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Miscellaneous: Claims Adjustments
Claims
Claims Adjustments
Claims
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CHARGES
COB
DATE
DIAGNOSIS
MEDICARE
PLACE
PROCEDURE
PROVIDER
SUBSCRIBER
D
O
Q
T
F
A
B
Q
X
I
S
D
I
A
G
N
O
S
I
S
U
F
P
S
B
F
B
Y
N
R
B
R
S
U
F
Q
A
X
O
E
S
T
S
E
F
B
U
E
C
D
C
A
E
R
Z
E
Z
C
K
I
R
S
G
A
T
U
C
N
H
V
I
X
R
C
E
N
S
A
V
O
B
W
A
I
T
V
V
D
L
R
E
J
H
D
A
C
Q
U
L
P
R
O
C
E
D
U
R
E
X
B
B
E
Z
M
J
D
H
N
B
T
T
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