Agency Schedule Detail

Authorization Number : 50750281

Agency Series No. : 2020-00-04

Status : Active

Agency Web Link :

Agency : ODM

Confidential Description : Protected Health Information (PHI) as defined by HIPAA.

Division : ODMHINQ

Vital Description : Pharmacy claims and prior authorization historical data required to process future pharmacy claims.

Section : ODMHINQ

Record Title : SPBM Pharmacy Program Data

Revision : 0

Record Description : All electronic and paper records associated with Single Pharmacy Benefit Manager (SPBM) Contractor administration of pharmacy benefits, including claims, prior authorizations, eligibility, customer service records, clinical data and data received from managed care organizations

Retention Period	Retention Justification	Media Code	Method of Disposal
10 years	Adherence to ODM-IPP 4501 Records Management Policy and in order to comply with federal regulation 42 CFR 422.504 [d][2][iii].	Paper	Shred
10 years	Adherence to ODM-IPP 4501 Records Management Policy and in order to comply with federal regulation 42 CFR 422.504 [d][2][iii].	Electronic	Erase

Approvals

Status	Name	Title	Date
Approved	Dennis Hawk	Records Coordinator	10/28/2020 10:45:28 AM
Approved	Katherine DuMond	Records Officer	11/2/2020 3:48:45 PM
Approved	Terri Dittmar	Record Administrator	11/3/2020 11:18:30 AM
Approved	Fred Previts	State Archivist	11/3/2020 11:54:39 AM
Approved	Martin Meeks	State Auditor	11/3/2020 1:35:49 PM

Notes

Date	Reason	User