AGENCY: Department of Health. Bureau of Information Technology
SERIES: 8281
TITLE: Early and periodic screening, diagnosis and treatment claim exception
DATES: 1985-2002.
ARRANGEMENT: None
DESCRIPTION: This is a list of claims for providers in this category 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; the recipient's aid category; the fund type and insurance codes; the type of examination given (vision, hearing, etc.) and if the results are normal, if treatment initiated, if the screener followed up or if a referral follow up is made; the type of lab test performed (urinalysis, sickle cell, etc.) and if the results are normal, if treatment initiated, if the screener followed up or if a referral follow up is made; if the patient was immunized for polio, DPT/TD, measles, mumps, rubella, and other; the date of screening; place and type of service; the provider number; the billing date; if referred to a specialist; the allowed screening charges; the submitted screening charges; other charges; the total submitted charges; amount of third party payments; and the net charges; of lock in or case management, the provider identification number; and if an error was committed, the error code, a 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