AGENCY: Department of Health and Human Services. Office of Children with Special Healthcare Needs

SERIES: 81999
TITLE: Vendor authorization payment log
DATES: 1982-
ARRANGEMENT: Numerical by authorization number

DESCRIPTION: This is a record of all vendors who have authorization to receive payments for services to handicapped patients. This form is also used for statistical purposes, to identify outstanding authorizations, and to track vendor claims. It includes the authorization number, the vendor's name, the type of service, the prescription date, the patient's name, the patient's number, the service date, the total claim amount, the amount to be paid by others, the identification of the other payer, and the amount to be paid by the state.

RETENTION

Retain for 2 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 06/1987

FORMAT MANAGEMENT

Paper: Retain in Office for 2 years and then destroy.

APPRAISAL

Administrative

This record has only administrative value. Retention in office is recommended due to the small quantity.

PRIMARY DESIGNATION

Private

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