AGENCY: Retirement Office. Division of Employees Group Insurance

SERIES: 83777
TITLE: Employees group insurance claim files
DATES: 1983-
ARRANGEMENT: Numerical by claim number

DESCRIPTION: This is a file of records that provide information of claims made to the state retirement system for payment. These document support claims against their medicare, medical, dental or disability insurance programs. This information is used when processing payment, payee information, eligibility of claim for payment, medical records supporting service rendered to insured. This file includes prescription drug claim form, claim for medical benefits form, claim for medical and extended benefits form, dental treatment form, name of insured, social security number, address phone number, date of birth of insured, date, prescription number, national drug code, metric quinty, total charges, name of pharmacy, address of pharmacy, signature of pharmacist, license number, name of dependent, signature of insured, signature of physicians or suppliers, procedure code, diagnosis code, and pre-authorized by.

This series contains; medical claims, pharmacy claims, manual claims, dental claims and medicare claims.

RETENTION

Retain for 5 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 07/1989

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year or until microfilmed and then destroy provided microfilm has passed inspection.

Microfilm master: Retain in State Records Center for 5 years and then destroy.

Microfilm duplicate: Retain in Office for 5 years and then destroy.

Microfilm duplicate: Retain in State Records Center for 5 years and then destroy.

APPRAISAL

Administrative Fiscal Legal

To up date RDR 62-89.

PRIMARY DESIGNATION

Private

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