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