AGENCY: Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Medicaid Operations.
SERIES: 7907
TITLE: Emergency transportation claim exception
DATES: 1977-
ARRANGEMENT: None
DESCRIPTION: This is a list of claims from emergency transportation services that exceed the norm for this group of medicaid providers. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run and report dates, the location code, the category of service, the clerk's identification number, the name of the employee entering the data on the terminal, the provider type code, the transaction control number, the recipient's name, age, sex, identification number, and date of birth, the provider's identification number, the type of insurance code number, the recipient aid category, the recipient fund type, whether the recipient has other resources, if the recipient is employed, if the treatment is for an emergency, an accident, and if auto related, the referring provider identification number, the prior approval number, the date of the accident, if any, whether EPSDT, child abuse, or family planning involved, the diagnosis codes, if a lock in or case management involved, the provider identification number, if any errors, the error code, the reason for the error, and the status of the error, the dates of the first and last service, the units, place and type of service codes, the procedure code, the diagnosis code, the EPSDT indicator codes, the submitted charges, the allowed charges source, and the amount of allowed charge, billing date, total charges, less third party payments, and the net charges.
RETENTION
Retain for 9 year(s)
DISPOSITION
Destroy.
RETENTION AND DISPOSITION AUTHORIZATION
These records are in Archives' permanent custody.
APPROVED: 08/1986
FORMAT MANAGEMENT
Computer output microfiche master: For records beginning in 1977 through 2002. Retain in Office for 2 years and then transfer to State Records Center. Retain in State Records Center for 7 years and then destroy.
CD-ROM: For records beginning in 2002 and continuing to the present. Retain in Office for 9 years and then destroy.
Computer data files: Retain in Office for 9 years and then delete.
APPRAISAL
Administrative
PRIMARY DESIGNATION
Private