AGENCY: Department of Health. Division of Medicaid and Health Financing. Bureau of Authorization and Community Based Services

SERIES: 8126
TITLE: Lost check tracer file
DATES: 1985-
ARRANGEMENT: None

DESCRIPTION: This is a file used to resolve claims by health care providers that they have not received payment for claims they have submitted. This record includes provider inquiry sheet, check loss affidavit, stop payment request, the date of inquiry, the name, address, and telephone number of the individual calling, the provider's name and identification number, the nature of the inquiry, the client's name and identification number, the amount of the missing payment, the date billed, the remittance date, the type of claim submitted, whether the claim was under medicare, the date the inquiry was researched, the date of response and if the provider was satisfied, the number of the lost warrant, the signature of the claimant, and the date a copy of the cancelled check was sent to the claimant or a stop payment was issued.

RETENTION

Retain for 5 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Paper: Retain in Office for 6 months and then transfer to State Records Center. Retain in State Records Center for 5 years and then destroy.

APPRAISAL

Administrative Legal

This retention period is set for 5 years in case legal action should be initiated over a missing check.

PRIMARY DESIGNATION

Private