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