AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8277
TITLE: Pharmacy claim exception
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: This is a list of claims from pharmacists 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 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, sex, age, identification number, and date of birth; the provider's identification number; the recipient's type insurance, aid category, and fund type codes; other insurance coverage; the drug name; prescription number; if prescription is a refill; the drug code; the prior authorization indicator and number; the dispensing date; the number of units; the prescriber's license number; the billed charge; the amount of any third party payment; the allowed charge source and amount; the billing date; the dispensing fee; if lock in or case management involved, the provider's identification number; and if an error, the error code, description of the error, and the status.

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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