AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8276
TITLE: Non-emergency transportation claim exception
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: This is a list of claims from non-emergency transportation companies that exceed the norm established for this group. 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 inputting the data; 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 identification number; the recipient's aid category; the recipient fund type code; if the recipient has other insurance; if the treatment an emergency; the prior approval number; the EPSDT indicator; if there is an error, the error code, description of the error, and the status code; the dates of service; the number of units or the number of miles; the place of service and the destination codes; the type of service; the amount of extra charge; the submitted charge amount; the allowed charge source, and the allowed charge amount; the billing date; the total charge; the amount of third party and recipient's 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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