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