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