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