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