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