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