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