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