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