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