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