AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8270
TITLE: Practitioner claim exception
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: This is a list of claims from medical practitioners that exceed the norm for that group. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run and report dates; the location code; the category of service; the clerk's identification number; the name of the employee entering the data on the terminal; 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 code number; the recipient aid category; the recipient fund type; whether the recipient has other resources; if the recipient is employed; if the treatment is for an emergency, an accident, and if auto related; the referring provider identification number; the prior approval number; the date of the accident, if any; whether EPSDT, child abuse, or family planning involved; the diagnosis codes; if a lock in or case management involved, the provider identification number; if any errors, the error code, the reason for the error, and the status of the error; the dates of the first and last service; the units, place and type of service codes; the submitted charges; the allowed charges source; and the amount of allowed charge, billing date, total charges, less third party payments, and the net charges.

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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