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