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