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