Agency Schedule Detail

Authorization Number : 50750270

Agency Series No. : 505-00-07

Status : Active

Agency Web Link :

Agency : ODM

Confidential Description : May contain provider and/or recipient claims information that is used to determine interim/final settlements made by the department for the various Medicaid programs.

Division : ODMFISC

Vital Description : Contains information used as support documentation for adjudication orders used in final settlements and rate calculations to support Medicaid provider rates and reimbursement.

Section : ODMFISCRSCS

Record Title : Medicaid Interim/Final Settlement & Rate Setting Packages

Revision : 0

Record Description : Interim/final settlements and rate setting packages of services provided by Medicaid providers, ex. Medicaid School Program (MSP), hospitals, PASSPORTS, public developmental centers, lead investigation, clinics. File contains but is not limited to cost report forms, settlement and rate setting work papers, settlement spreadsheets and other documentation supporting the interim/final settlements and rate setting/rate adjustments.

Retention Period	Retention Justification	Media Code	Method of Disposal
In office and /or in storage, retain for 7 years from adjudication date or date used for rate setting purposes then destroy provided all monies due the department have been collected and all discrepancies are resolved.	Based on CMS guidance for record retention of financial and compliance records.	Paper	Shred
On department computers or department''s shared drives, retain for 7 years from adjudication date or date used for rate setting purposes then destroy provided all monies due the department have been collected and all discrepancies are resolved.	Based on CMS guidance for record retention of financial and compliance records.	Electronic	Delete

Approvals

Status	Name	Title	Date
Approved	Tiffany Williams	Records Coordinator	4/27/2018 10:31:00 AM
Approved	Lisa Stafford	Records Officer	5/1/2018 9:08:00 AM
Approved	Bunnie Jones	Record Administrator	5/10/2018 8:53:00 AM
Approved	Martin Meeks	State Auditor	5/14/2018 10:21:00 AM
Approved	Fred Previts	State Archivist	5/14/2018 1:52:00 PM

Notes

Date	Reason	User