AGENCY: Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Medicaid Operations.

SERIES: 17425
TITLE: Electronic data transmission logs and reports
DATES: 1987-
ARRANGEMENT: Chronological, thereunder numerical by internally assigned number

DESCRIPTION: These logs and reports document the data entry of claims submitted electronically for reimbursement for services covered by medicaid. These documents are used as the source document for the data entry and serve as evidence that the claim has been processed. Includes the script questionnaire or the direct bill transfer control form and the CP152 Report. These forms contain information about: the julian date of the batch, the batch number, number of claims (invoices) in the batch, claim type (e.g., dental, HCFA), claim code, total submitted charge, name of health care provider, and contact name and phone number of the file submitter.

RETENTION

Retain for 5 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 06/1997

FORMAT MANAGEMENT

Paper: Retain in Office for 6 months and then transfer to State Records Center. Retain in State Records Center for 5 years and then destroy.

APPRAISAL

Administrative Fiscal

This disposition is based on the administrative needs expressed by the agency for conducting audits. Medicare Payment Records are Office of Health Care Financing for 9 years.

PRIMARY DESIGNATION

Private

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