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