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