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