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