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