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