AGENCY: Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Eligibility Policy

SERIES: 7948
TITLE: Hospital utilization post-payment review case files
DATES: 1984-
ARRANGEMENT: Chronologically by date, thereunder by case file number.

DESCRIPTION: This series contains random, sample reviews of services provided to medicaid recipients. The reviewing process helps to ensure the necessity of provided services. Included in this record are post-payment claim review data entry forms, case summaries of review actions, hospital admission screening review forms, appropriateness evaluation protocols, psychiatric admission appropriateness criteria, appropriateness of day of care information, requests for patients' medical records, notifications of findings, patients' medical records, claim histories, and override option sheets. Information contained within the records includes case file numbers, sample months and numbers, dates of review, hospital names, patients' names and ages, gender, total days of stay, diagnoses, treatments prescribed, surgical procedures, attending and admitting physicians' names, review results, names of persons reviewed, review findings, and dates of findings.

RETENTION

Retain for 12 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 12/1997

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then transfer to State Records Center. Retain in State Records Center for 11 years and then destroy.

APPRAISAL

Administrative Fiscal Legal

These records are mandated by 42 Code of Federal Regulation 456.23 and are subject to federal audit.

PRIMARY DESIGNATION

Private