AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8268
TITLE: Outpatient hospital claim exception
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: These are outpatient hospital claims that exceed the parameters established as normal by the MMIS. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run and report dates; the location number; the clerk's identification number; the name of the employee entering the data on the terminal; the medical records number; the provider type code; the transaction control number; the recipient's name, age, sex, identification number, and date of birth; the provider's identification number; the type of insurance, if any; the recipient's aid category; the fund type code; if the recipient is employed; if the treatment is for emergency, accident, or auto related; the referring provider's identification number; the identity of the recipient's insurance company; the prior approval number; the date of the accident, if any; whether the recipient is in Early and Periodic Screening, Diagnosis, and Treatment (EPSDT); whether child abuse is involved; if the treatment is related to family planning; if the patient is in lock or in case management, and, if so, the provider identification number; and a record of services rendered, giving the dates of first and last services, the units of service, the place and type of service, the procedure code, the diagnosis code, the EPSDT indicator code, the submitted charge, the allowed charge source, and the amount of allowed charge.

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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