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