AGENCY: Department of Health. Bureau of Information Technology
SERIES: 8279
TITLE: Inpatient hospital claim exception
DATES: 1985-2002.
ARRANGEMENT: None
DESCRIPTION: This is a list of hospital claims for inpatient services 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 entering the data; the medical records number; the provider type; 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 the recipient is in lock in or case management; the recipient's aid category; the fund type and insurance codes; whether the treatment is for EPSDT, family planning, auto related, or other accident; if employed; the prior approval number and indicator; the referring provider's license number; the attending physician's and the admitting physician's license numbers; the admission date, hour, and type; the beginning and ending dates of service; the admitting diagnosis; the surgeon(s) license number; the surgery date(s); the surgical procedure code(s); the total days in hospital; the number of covered and non-covered days; the discharge date or the date of death; the status code (still a patient or discharged); if child abuse is involved; the billing date; the bill type; the committed exceptions; and if there is an error, the error code number, description of the error, and the status code; and a statement of services that gives a description of the services, the number of days in hospital, the daily rate, the total charges, the non-covered amount, and the source and amount of allowed 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