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