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