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

SERIES: 7919
TITLE: Medicare crossover rejections
DATES: 1977-
ARRANGEMENT: None

DESCRIPTION: This is a list of claims submitted for recipients who are also receiving medicare benefits and who are not eligible for medicaid payments. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run date, location code, transaction control number, the recipient's name, sex, age, identification number, and date of birth, the provider number, the provider category of service, the procedure code, diagnosis code, amount paid by medicare, total claims charges, third party amount, non-covered amount, net charges, co-insurance amount, deductible amount, and the amount to be paid by medicaid, the dates of service, the total days of service, the date medicare received, the dates medicare and medicaid paid, and if an error, the error code, a 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

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