AGENCY: Department of Health. Division of Medicaid and Health Financing. Bureau of Authorization and Community Based Services

SERIES: 8125
TITLE: Advance payment program report
DATES: 1985-
ARRANGEMENT: None

DESCRIPTION: This is a computer output also used as an input document. This is used to inform the bureau of any payments to the health care providers and they in turn input the information into their system. This record includes the run and report date, the name and identification number of the heath care provider, the advance payment program amount, the beginning amount, the amount of submitted claims, the adjusted advance payment program amount, the paid amount, and the ending advance payment program amount.

RETENTION

Retain for 1 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

Administrative

Several copies of this report are generated. Therefore, this bureau need not keep its copy past its administrative value.

PRIMARY DESIGNATION

Private

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