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