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