Agency Schedule Detail

Authorization Number : 855-1113

Agency Series No. : MSAD-30

Status : Active

Agency Web Link :

Agency : BWC

Confidential Description : The medical providers’ tax identification numbers, names of injured workers, claim numbers, medical information for services, equipment and/or prescriptions, and payment amounts.

Division : BWCMSAD

Vital Description :

Section : BWCMSAD

Record Title : Hospital Reimbursement Appeals

Revision : 0

Record Description : Hospitals may appeal the payment amount of their bill by submitting supporting documentation and justification for any changes. The Hospital Reimbursement Review (HRR) Unit reviews the appeal and issues a response to the hospital via email or in letter form.

Retention Period	Retention Justification	Media Code	Method of Disposal
Retain the Hospital Reimbursement Appeals in the HRR Unit for 2 years after resolution, provided audited by the Auditor of State, audit report is release, and then destroy.		Paper	Shred
Retain the Hospital Reimbursement Appeals in the HRR Unit for 2 years after resolution, provided audited by the Auditor of State, audit report is release, and then destroy.		Electronic	Delete

Approvals

Status	Name	Title	Date
Approved	Kevin Gartrell	Records Coordinator	8/27/2009 3:48:00 PM
Approved	Melissa Roach	Records Officer	8/31/2009 4:39:00 PM
Approved	Michael Hardenbrook	Record Administrator	9/8/2009 1:20:00 PM
Approved	Martin Meeks	State Auditor	9/8/2009 3:46:00 PM
Approved	Fred Previts	State Archivist	9/9/2009 10:15:00 AM

Notes

Date	Reason	User