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Miscellaneous: Claims Adjustments
Claims
Claims Adjustments
Claims
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CHARGES
COB
DATE
DIAGNOSIS
MEDICARE
PLACE
PROCEDURE
PROVIDER
SUBSCRIBER
J
V
G
N
F
K
G
X
S
B
S
O
B
L
Y
L
T
I
E
X
U
D
A
Y
P
P
A
V
G
R
B
U
I
G
V
J
P
P
R
E
S
E
J
A
F
F
K
W
A
D
C
L
R
O
G
E
P
H
H
I
R
O
L
A
D
N
C
P
C
V
I
E
B
I
C
K
O
A
R
O
B
A
T
U
F
I
P
S
L
R
E
Y
J
A
N
C
D
Q
I
P
R
O
C
E
D
U
R
E
A
S
H
V
E
U
J
Z
F
O
M
A
Z
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