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