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