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