AGENCY: Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Eligibility Policy
SERIES: 7982
TITLE: Medicaid Management Information System remittance statement
DATES: 1981-
ARRANGEMENT: None
DESCRIPTION: This is a computer output microfiche number 68015A produced weekly showing the medicaid claims paid, denied, and in process. It includes the report date, the name of the health care provider, the provider's identification number, and the category of service. Other information is as follows: Claims paid: gives name and client identification number of the recipient, the transaction control number, the first date of service, the amount of total charges, the amount of recipient co-payment, the amount of payment from other sources, the claim amount paid, the dates of service, the units of service, the amount of submitted charges, the amount of allowed charges, an explanation for the allowed charges, and a total of all payments to that provider for that category of service. Claims in process: gives the recipient name and claim identification number, the transaction control number, the dates of service, the total charges, and the total of all charges for that provider for that category of service. Claims denied: gives recipient name and client identification number, the transaction control number, the dates of service, the total charges, and the reasons for the denial.
RETENTION
Retain until administrative need ends
DISPOSITION
Destroy.
RETENTION AND DISPOSITION AUTHORIZATION
These records are in Archives' permanent custody.
APPROVED: 08/1986
FORMAT MANAGEMENT
Paper: 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
This record is duplicate. The master copy is being retained for 10 years. Once this fiche is no longer needed in the office, it may be disposed of.
PRIMARY DESIGNATION
Private