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