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