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