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