AGENCY: Department of Health. Special Care Administration
SERIES: 8607
TITLE: Health insurance claim form
DATES: 1984-1986.
ARRANGEMENT: Alphabetical by name
DESCRIPTION: These are billings received from psychologists for services rendered to clients participating in the Social Services Health Plan. These forms include patient's name, address, telephone number, date of birth, and sex, name and address of the insured party, the insured's identification number and group number, the relationship between the patient and the insured, the name, address, policy number, and policy holder of other health insurance coverage, if any; whether the patient's condition was related to his/her employment or an accident; the signatures and dates of signature of the patient and the person who is to authorize payment; the date of the illness or injury, the date the patient first consulted the provider, the date the patient can return to work, and if the patient is disabled, the dates of partial or total disability; whether the patient has previously had these symptoms, the name of the referring health care provider, the provider license number, the dates the patient admitted to and discharged from a hospital, the name and address of the medical facility where the services were rendered, whether laboratory work was performed and the amount of charges, the diagnosis, the dates of medical service, the place of service, the procedure code, a description of the services and supplies furnished for each date, the amount of the charges, the name, address, and identification number of the provider or supplier, the provider type, the social security number, employer identification number, the signature of the provider or supplier, the patient's account number, the total charge, the amount paid by the patient, and the date the form was completed.
RETENTION
DISPOSITION
RETENTION AND DISPOSITION AUTHORIZATION
These records are in Archives' permanent custody.
APPROVED: 10/1986
FORMAT MANAGEMENT
Paper: Retain in Office for 2 years and then transfer to State Records Center. Retain in State Records Center for 7 years and then destroy.
APPRAISAL
Administrative Fiscal Legal
45 CFR 455 requires the state to investigate complaints of medicaid fraud or abuse, but does not specify how far back in time the agency can investigate. UCA title 26, chapter 20 makes false claims for medical benefits a second degree felony. UCA 76-1-302 states that a prosecution for a felony must begin within 4 years after it is committed. This information could also be used to demand reimbursement from a parent for medical expenses paid by the state. The statute of limitations for demanding reimbursement for medical expenses paid by the state is 8 years, UCA 78-12-22. 31 USCS 3729 defines false claims for payments against the federal government and includes medical insurance claims. 31 USCS 3731 sets a statute of limitations for bringing action on false claims of 6 years. However, two court cases stated that the statute of limitations for medicare overpayments did not begin to run until after the provider had beeen audited: US v Normandy House Nursing Home, Inc DC Mass 1977 428 Federal Suppliment 421 Civ A No 75-950-F, and US v Pisani CA NJ 1981 646 Federal Reporter 2nd Series 83. According to the Denver Regional office of the Health Care Financing Agency, the government has 3 years in which to audit these records.
PRIMARY DESIGNATION
Private
SECONDARY DESIGNATION
Controlled. UCA 63G-2-304 1992