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