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