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