AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8273
TITLE: Dental claims exception
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: This is a list of claims from dentists that exceed the norm for this group of providers. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run and report dates; the category of service; the location code; the clerk's identification number; the name of the employee entering the data in the terminal; the provider type code; the transaction control number; the name, sex, age, identification number, and date of birth of the recipient; the dentist's identification number; the recipient's type insurance code; the aid category code; the fund type code; if the recipient has other insurance; if the treatment is due to accident, auto related, EPSDT, or child abuse; the referring provider; identification number; the prior authorization number; the committed exceptions code; if error is made, the error code, the type of error, and the status; the tooth number and tooth surface codes; the place, date, and type of service; the procedure code; the submitted charge; the allowed charge; the source and amount of allowed charge; the billing date; the total charge; the amount of third party payments, if any; the amount of recipient payments; and the net 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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