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

SERIES: 7912
TITLE: Pharmacy claim exception
DATES: 1977-
ARRANGEMENT: None

DESCRIPTION: This is a list of claims from pharmacists that exceed the norm established for this group. This is part of COM number 68015E, MMIS Claims Exception Reports. It includes run and report dates, the category of service, the location code, the clerk identification number, the name of the employee entering the data on the terminal, the medical records number, the provider type code, the transaction control number, the recipient's name, sex, age, identification number, and date of birth, the provider's identification number, the recipient's type insurance, aid category, and fund type codes, other insurance coverage, the drug name, prescription number, if prescription is a refill, the drug code, the prior authorization indicator and number, the dispensing date, the number of units, the prescriber's license number, the billed charge, the amount of any third party payment, the allowed charge source and amount, the billing date, the dispensing fee, if lock in or case management involved, the provider's identification number, and if an error, the error code, description of the error, and the status.

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