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Miscellaneous: Claims Adjustments
Claims
Claims Adjustments
Claims
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CHARGES
COB
DATE
DIAGNOSIS
MEDICARE
PLACE
PROCEDURE
PROVIDER
SUBSCRIBER
I
S
S
M
O
C
Y
O
G
K
U
P
R
O
C
E
D
U
R
E
E
I
L
R
E
T
H
D
A
X
P
V
F
A
D
O
B
G
A
I
T
Y
V
I
C
O
K
V
I
F
R
C
E
I
X
E
E
Q
A
I
R
E
G
A
Q
N
C
V
K
D
T
D
C
D
E
R
Q
X
R
V
D
P
O
E
S
L
S
E
S
H
A
B
B
F
E
R
B
S
D
K
J
X
B
Z
S
G
V
O
U
N
G
S
I
S
O
N
G
A
I
D
S
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