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