AGENCY: Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Medicaid Operations.

SERIES: 7913
TITLE: In-patient hospital claim exception
DATES: 1977-
ARRANGEMENT: None

DESCRIPTION: This is a list of hospital claims for in-patient services that exceed the norm established for this group. This is part of COM number 68015E, MMIS Claim Exception Reports. It includes run and report dates; the category of service; the location code; the clerk's identification number; the name of the employee entering the data; the medical records number; the provider type; 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; if the recipient is in lock in or case management; the recipient's aid category; the fund type and insurance codes; whether the treatment is for EPSDT, family planning, auto related, or other accident; if employed; the prior approval number and indicator; the referring provider's license number; the attending physician's and the admitting physician's license numbers; the admission date, hour, and type; the beginning and ending dates of service; the admitting diagnosis; the surgeon(s) license number; the surgery date(s); the surgical procedure code(s); the total days in hospital; the number of covered and non-covered days; the discharge date or the date of death; the status code (still a patient or discharged); if child abuse is involved; the billing date; the bill type; the committed exceptions; and if there is an error, the error code number, description of the error, and the status code; and a statement of services that gives a description of the services, the number of days in hospital, the daily rate, the total charges, the non-covered amount, and the source and amount of allowed 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 Fiscal

PRIMARY DESIGNATION

Private