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