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