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