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