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