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