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