AGENCY: Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Medicaid Operations.
SERIES: 7909
TITLE: Dental claims exception
DATES: 1977-
ARRANGEMENT: None
DESCRIPTION: This is a list of claims from dentists that exceed the norm for this group of providers. This is part of COM number 68015E, MMIS Claims Exception Reports. It includes run and report dates, the category of service, the location code, the clerk's identification number, the name of the employee entering the data in the terminal, the provider type code, the transaction control number, the name, sex, age, identification number, and date of birth of the recipient, the dentist's identification number, the recipient's type insurance code, the aid category code, the fund type code, if the recipient has other insurance, if the treatment is due to accident, auto related, EPSDT, or child abuse, the referring provider's identification number, the prior authorization number, the committed exceptions code, if error is made, the error code, the type of error, and the status, the tooth number and tooth surface codes, the place, date, and type of service, the procedure code, the submitted charge, the allowed charge, the source and amount of allowed charge, the billing date, the total charge, the amount of third party payments, if any, the amount of recipient payments, and the net charge.
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