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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
M
G
E
C
C
B
I
Y
R
O
R
U
F
S
R
E
C
U
E
L
I
D
G
B
I
E
A
E
D
D
E
H
G
I
R
S
M
G
C
T
A
R
O
X
U
A
E
C
H
R
I
A
U
K
D
Z
D
G
D
R
P
A
D
D
B
E
A
Y
P
N
I
I
V
H
E
L
C
L
R
Q
M
O
V
B
O
C
M
A
I
S
B
F
W
S
O
E
O
Y
L
W
T
F
Q
Y
B
I
R
R
N
P
S
A
Z
O
M
Z
Q
S
P
O
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