AGENCY: Department of Health. Division of Medicaid and Health Financing. Bureau of Authorization and Community Based Services

SERIES: 8124
TITLE: Practitioner claim exception
DATES: 1985-
ARRANGEMENT: None

DESCRIPTION: This is a weekly computer output report of those claims submitted by health care providers that appear to be outside the parameter of the average medical claims. This record 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 employee, 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 child abuse or family planning is involved, the diagnosis codes, if a lock in or case management is 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 submitted charges, the allowed charge source, and the amount of allowed charge, the billing date, the total charges, less third party payments, and the net charges.

RETENTION

Retain until administrative need ends

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Paper: Retain in Office until no longer administratively valuable and then destroy.

APPRAISAL

Administrative

This record is placed on microfiche and is stored for long term retention in that manner. Therefore, the paper copy need only be kept for as long as it is needed in the office.

PRIMARY DESIGNATION

Private