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