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