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