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