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