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