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