AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8289
TITLE: Indigent eligibility/need exception
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: This is a list of claims submitted for indigents which exceed the norm established for that group. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run and report dates; the location code; the clerk's identification number; the name of the employee entering the data to the system; the transaction control number; the recipient's name, sex, age, identification number, and date of birth; the provider's identification number; the prior authorization number; the effective and termination dates; the reviewer's identification number, if the reviewer signed the claim, and the date of the signature; if an error occurred, the error code, description of the error, and the status; and a statement of services giving the drug, supply, or procedure codes, the requested units, and the approved units.

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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