Authorization Number : 50750267
Agency Series No. : 505-00-06
Status : Active
Agency Web Link :
Agency : ODM
Confidential Description : Records may contain individual private Protected Health Information (PHI), Confidential Personal Information (CPI), Personally Identifiable Information (PII), or State Sensitive Information (SSI).
Division : ODMOPER
Vital Description :
Section : ODMOPERNETM
Record Title : Provider Network Management Records Retention
Revision : 1
Record Description : The Provider Network Management system receives data from potential and current providers for enrollment, disenrollment, certification, revalidation, and credentialing purposes to be a Medicaid provider. This data contains information such as name, date of birth, social security number, driver''s license number, address and professional certification documents. The system also contains claims data and recipient eligibility and immunization records from other systems.