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