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Agency Schedule Detail

Authorization Number :  50750013
Agency Series No. :  415-01-14
Status :  Active
Agency Web Link : 
Agency :  ODM
Confidential Description :   May contain Medicaid recipient personal medical information.
Division :  ODMOPER
Vital Description : 
Section :  ODMOPERMITS
Record Title :  Medicaid Management Information System (MMIS) Reference File Sub-System
Revision :  1
Record Description :  Forms (JFS 06660,06662,06663,6679,6680,6681,6682,and 6683) and supporting documentation used to make changes and/or addition to the reference file sub-system of the Medicaid Management Information System(MMIS) for procedure, drug, diagnosis, and provider charge file fees under the Medicaid Program. File contain the required approval signatures for the change request, date of approval, and date the documentation was received and entered into the on-line system. The files are reference repeatedly as Medicaid invoices are processed to determine the quantity and or amount of payment to providers. System reports include procedure, drug, diagnosis codes, and provider charge file codes.
Retention Period Retention Justification Media Code Method of Disposal
Retain until superseded, obsolete or replaced, then destroy. Long term retention is required to verify services and payments to providers. Electronic Erase
Retain in office 3 years or until audit reviews are completed, reports released and all discrepancies are resolved, and then digitally image. Destroy hard copy 90 days after quality control has been completed. Long term retention is required to verify services and payments to providers. Paper Shred

Approvals

Status Name Title Date
Approved Dennis Hawk Records Coordinator 2/4/2019 4:23:00 PM
Approved Lisa Stafford Records Officer 2/6/2019 3:33:00 PM
Approved Terri Dittmar Record Administrator 2/7/2019 7:38:00 AM
Approved Fred Previts State Archivist 2/11/2019 10:50:00 AM
Approved Martin Meeks State Auditor 2/15/2019 2:34:00 PM

Notes

Date Reason User

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