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