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