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

SERIES: 19003
TITLE: Medicare crossover transaction report
DATES: 1997-
ARRANGEMENT: Numerical by transaction control number

DESCRIPTION: This is a list of Medicare claims that are crossed over to Medicaid claims for Medicaid partial payment. The report includes the medicare document number, medicaid transaction control number, recipient ID number, provider number, co-insurance amount, deductable amount, Medicare payment amount, payment date, Medicaid amount, Medicaid payment date and disposition code.

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

Paper: For records beginning in 1997 through 2001. Retain in Office until microfiched and then destroy.

Microfiche master: For records beginning in 1997 through 2001. Retain in Office for 7 years 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 provided erased records are those stored on COLD/LAN.

APPRAISAL

Administrative

PRIMARY DESIGNATION

Private