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