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