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