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