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