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