AGENCY: Department of Health. Bureau of Information Technology

SERIES: 8290
TITLE: Prior authorization request exception
DATES: 1985-2002.
ARRANGEMENT: None

DESCRIPTION: This is a list of prior authorization request that 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 signature; if an error occurred, the error code, description of the error, and the status; and a statement of services broken down by estimated units and cost, approved units and cost, and units used and cost; if recipient hospitalized, the provider identification number, the estimated number of days in the hospital, the hospital procedure code, the approved days stay, sterilization data, reviewer identification number, if the reviewer signed the claim and the signature date.

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

---