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

SERIES: 7906
TITLE: Practitioner claim exception
DATES: 1977-
ARRANGEMENT: None

DESCRIPTION: This is a list of claims from medical practitioners that exceed the norm for that group. This is part of COM number 68015E, MMIS Exception Reports. It 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 employed; 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 EPSDT, child abuse, or family planning involved; the diagnosis codes; if a lock in or case management 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 EPSDT indicator codes; the submitted charges; the allowed charges source; and the amount of allowed charge; billing date; total charges; less third party payments; and the net charges.

RETENTION

Retain for 9 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Computer output microfiche master: For records beginning in 1977 through 2002. Retain in Office for 2 years and then transfer to State Records Center. Retain in State Records Center for 7 years and then destroy.

CD-ROM: For records beginning in 2002 and continuing to the present. Retain in Office for 9 years and then destroy.

Computer data files: Retain in Office for 9 years and then delete.

APPRAISAL

Administrative

PRIMARY DESIGNATION

Private