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

SERIES: 7911
TITLE: Non-emergency transportation claim exception
DATES: 1977-
ARRANGEMENT: None

DESCRIPTION: This is a list of claims from non-emergency transportation companies that exceed the norm established for this group. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run and report dates, the category of service, the location code, the clerk's identification number, the name of the employee inputting the data, the medical records number, the provider type code, the transaction control number, the recipient's name, age, sex, identification number, and date of birth, the provider identification number, the recipient's aid category, the recipient fund type code, if the recipient has other insurance, if the treatment an emergency, the prior approval number, the EPSDT indicator, if there is an error, the error code, description of the error, and the status code, the dates of service, the number of units or the number of miles, the place of service and the destination codes, the type of service, the amount of extra charge, the submitted charge amount, the allowed charge source, and the allowed charge amount, the billing date, the total charge, the amount of third party and recipient's payments, and the net charge.

RETENTION

Retain for 9 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Computer output microfiche master: For records beginning in 1977 through 2002. Retain in Office for 2 years and then transfer to State Records Center. Retain in State Records Center for 7 years and then destroy.

CD-ROM: For records beginning in 2002 and continuing to the present. Retain in Office for 9 years and then destroy.

Computer data files: Retain in Office for 9 years and then delete.

APPRAISAL

Administrative Fiscal

PRIMARY DESIGNATION

Private