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