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