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