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

SERIES: 7923
TITLE: Prior authorization request exception
DATES: 1977-
ARRANGEMENT: None

DESCRIPTION: This is a list of prior authorization request that exceed the norm established for that group. This is part of COM 68015E, MMIS Claims Exception Reports. It includes run and report dates, the location code, the clerk's identification number, the name of the employee entering the data to the system, the transaction control number, the recipient's name, sex, age, identification number, and date of birth, the provider's identification number, the prior authorization number, the effective and termination dates, the reviewer's identification number, if the reviewer signed the claim, and the date of signature, if an error occurred, the error code, description of the error, and the status, and a statement of services broken down by estimated units and cost, approved units and cost, and units used and cost; if recipient hospitalized, the provider identification number, the estimated number of days in the hospital, the hospital procedure code, the approved days stay, sterilization data, reviewer identification number, if the reviewer signed the claim and the signature date.

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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