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