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