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

SERIES: 7890
TITLE: Long-term care turnaround document
DATES: 1985-
ARRANGEMENT: None

DESCRIPTION: These are to reimburse long term care providers for services rendered under the medicaid and medicare programs. This document includes document number, a list of clients and the charges for service to those clients giving the client identification number, client name, the location, the daily charge, beginning and ending dates of service, the current monthly charge, the client's income resources from family and from other sources, the current net charge, the document number, the total days billed, the number of hospital leave days, their leave days, the discharge date, the discharge diagnosis, the name, address, and identification number of the health care provider, the signature of the provider, and the billing date.

RETENTION

Retain until administrative need ends

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 01/1986

FORMAT MANAGEMENT

Paper: Retain in Office for 1 month and then transfer to State Records Center. Retain in State Records Center for 11 months and then microfilm and destroy provided microfilm has passed inspection.

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

Computer output microfiche master: Retain in State Records Center until no longer administratively valuable and then destroy.

APPRAISAL

Administrative Fiscal

Previous decision: RDR 79-142: 1 year and microfilm/confidential.

PRIMARY DESIGNATION

Private