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