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