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