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

SERIES: 7929
TITLE: Medical payments bureau remittance statement
DATES: 1976-
ARRANGEMENT: None

DESCRIPTION: This is computer output microfiche number 68015A produced weekly showing the medicaid claims paid, denied, and in process. It includes the report date, the name of the health care provider, the provider's identification number, and the category of service. Other information is as follows: Claims paid: gives name and client identification number of the recipient, the transaction control number, the first date of service, the amount of total charges, the amount of recipient co-payment, the amount of payment from other sources, the claim amount paid, the dates of service, the units of service, the amount of submitted charges, the amount of allowed charges, an explanation for the allowed charges, and a total of all payments to that provider for that category of service. Claims in process: gives the recipient name and claim identification number, the transaction control number, the dates of service, the total charges, and the total of all charges for that provider for that category of service. Claims denied: gives recipient name and client identification number, the transaction control number, the dates of service, the total charges, and the reasons for the denial.

RETENTION

Retain for 9 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 03/2003

FORMAT MANAGEMENT

Computer output microfiche master: For records beginning in 1976 through 2001. Retain in Office for 1 year and then transfer to State Records Center. Retain in State Records Center for 1 year and then destroy.

CD-ROM: For records beginning in 2001 and continuing to the present. Retain in Office for 9 years and then destroy.

Computer data files: For records beginning in 2001 and continuing to the present. Retain in Office for 9 years and then delete.

APPRAISAL

Administrative Fiscal

Discussion with the staff indicates that they need only one of seven copies of this fiche and that they need it two years. As there are nine other copies and a master of this fiche, keeping the fiche beyond its office use is unnecessary.

PRIMARY DESIGNATION

Private