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