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