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