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