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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
R
C
X
B
Y
D
O
H
Y
D
P
R
O
C
E
D
U
R
E
E
I
R
M
E
D
I
C
A
R
E
I
A
O
M
S
B
C
H
B
T
F
Y
G
V
P
R
X
I
A
O
D
E
I
N
I
L
W
L
O
R
U
D
G
Z
O
D
A
D
J
X
G
C
A
A
O
S
E
C
N
J
U
E
O
S
E
O
I
R
E
X
C
C
S
B
K
B
A
S
B
A
K
A
N
O
U
L
T
U
O
T
K
M
F
E
N
S
S
L
B
S
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