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