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