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