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