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