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