AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8285
TITLE: Medicare crossover rejections
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: This is a list of claims submitted for recipients who are also receiving medicare benefits and who are not eligible for medicaid payments. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run date; location code; transaction control number; the recipient's name, sex, age, identification number, and date of birth; the provider number; the provider category of service; the procedure code; diagnosis code; amount paid by medicare; total claims charges; third party amount; non-covered amount; net charges; co-insurance amount; deductible amount; and the amount to be paid by medicaid; the dates of service; the total days of service; the date medicare received; the dates medicare and medicaid paid; and if an error, 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

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