AGENCY: Davis County (Utah). Health Department. Administration Division

SERIES: 18963
TITLE: Insurance billing records
DATES: 1997-2018.
ARRANGEMENT: Alphabetical by patient's name

DESCRIPTION: This worksheet is used to bill insurance companies, Medicaid Aging waiver, and New Choice waiver. It includes date of service, patient information (name, address, telephone number, sex, date of birth, sex, and social security number); insurance information (insurance company name, subscriber's name, policy number, employer name); charges (code and amount); a listing of services, code, and charge (office procedures, laboratory services, immunizations and medications, and perinatal services); diagnosis, total charges, and amount paid.

RETENTION

Retain for 1 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series is proposed and has not yet been approved.

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

Administrative

PRIMARY DESIGNATION

Private

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