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