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