Agency Schedule Detail

Authorization Number : 50000064

Agency Series No. : 038-0021_A

Status : Active

Agency Web Link :

Agency : ADA

Confidential Description :

Division :

Vital Description :

Section :

Record Title : Medicaid ARA Reports (Agency Remittance Advice)

Revision : 1

Record Description : Electronic reports for each board generated every two weeks from data received from JFS that includes client name, patient history information (42CFR), type of service, date of service, total charged, 3rd party & FFP amount (fed funds participant).

Retention Period	Retention Justification	Media Code	Method of Disposal
7 years. Stored on server for 6-12 months then transferred to disk.	Medicaid billing information.	Electronic	Erase

Approvals

Status	Name	Title	Date
Approved	Lisa Winland	Records Officer	7/31/2011 11:07:00 AM
Approved	Michael Hardenbrook	Record Administrator	8/3/2011 12:34:00 PM
Approved	Martin Meeks	State Auditor	8/4/2011 4:19:00 PM
Approved	Fred Previts	State Archivist	8/10/2011 12:43:00 PM

Notes

Date	Reason	User