AGENCY: Department of Health. Division of Medicaid and Health Financing. Bureau of Authorization and Community Based Services
SERIES: 8148
TITLE: Medical claims
DATES: 1985-
ARRANGEMENT: None
DESCRIPTION: These are reimbursement claims filed by medical providers for services covered by medicare and medicaid. This record includes dentists invoices, health insurance claim forms, pharmacy claim forms, outpatient claims, long-term care turnaround documents, the patient's name, address, telephone number, date of birth, sex; the name and address of the insured party, the insured's identification number and group number; the relationship between the patient and the insured; information on health insurance coverage, if any; the signatures and dates of signature of the patient and the person who is to authorize payment; the date of the illness or injury; the date the patient first received treatment; the name of a referring physician, if any, and the provider identification number; if the treatment was due to accident, Early and Periodic Screening, Diagnosis and Treatment Services, or child abuse; the prior authorization number; a description of the service provided; the procedure code; the charge per service; the name, address, and provider number of the health care provider; the total charges; the signature of the reviewer and the date the form was reviewed; and the signature and date of signature of the health care provider.
RETENTION
Retain for 7 year(s)
DISPOSITION
Destroy.
RETENTION AND DISPOSITION AUTHORIZATION
These records are in Archives' permanent custody.
APPROVED: 07/2011
FORMAT MANAGEMENT
Paper: Retain in Office for 7 years and then destroy.
Microfilm master: Retain in Archives for 7 years and then destroy.
Microfilm duplicate: Retain in Archives for 7 years and then destroy.
APPRAISAL
Administrative
This copy of microfilm is one of seven. Another copy has been designated the record copy, so there is no need for the bureau to keep their copy after its office use ends.
PRIMARY DESIGNATION
Private
SECONDARY DESIGNATION
Controlled