AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8264
TITLE: Pre-admission continued stay
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: This is a list of pre-admission/continued stay approval forms input into MMIS. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run and report dates; the location code; the identification number of the clerk inputting the data; the name of the individual unputting the data; the transaction control number; the recipient's name, age, sex, identification number, date of birth, and address; the provider's identification number; the recipient's insurance type code; the recipient's aid category code; the recipient's fund type code; whether the recipient has other insurance; if the recipient has received medicare, the dates of service and the medicare identification number; the patient's admission dates; the attending and admitting physicians' license numbers; the name and telephone number of the responsible party; the diagnostic codes and onset dates; the surgical procedures codes and dates; and the approved level of care codes and the beginning and ending dates.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Computer output microfiche master: Retain in Office for 1 year and then transfer to State Records Center. Retain in State Records Center for 9 years and then destroy.

APPRAISAL

Administrative Legal

PRIMARY DESIGNATION

Private

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