Series 7948
Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Eligibility Policy
Hospital utilization post-payment review case files, 1984-
View history of records' creator.
View retention schedule.
Schedule Description
This series contains random, sample reviews of services provided to medicaid recipients. The reviewing process helps to ensure the necessity of provided services. Included in this record are post-payment claim review data entry forms, case summaries of review actions, hospital admission screening review forms, appropriateness evaluation protocols, psychiatric admission appropriateness criteria, appropriateness of day of care information, requests for patients' medical records, notifications of findings, patients' medical records, claim histories, and override option sheets. Information contained within the records includes case file numbers, sample months and numbers, dates of review, hospital names, patients' names and ages, gender, total days of stay, diagnoses, treatments prescribed, surgical procedures, attending and admitting physicians' names, review results, names of persons reviewed, review findings, and dates of findings.
Scope and Content
This record series contains sample reviews, taken at random, of services provided to medicaid recipients. This reviewing process helps to ensure that services provided to patients are indeed necessary. This review is mandated by the Code of Federal Regulations. Included in this record are post-payment claim review data entry form; a case summary of the actions taken during the review; hospital admission screening review form; appropriateness evaluation protocol; criteria of psychiatric admission appropriateness; appropriateness of day of care; request for patient's medical record; notification of findings; patient's medical records; claim history; and override option sheets.__Information contained within the records includes: case file number; sample month; sample number; date of review; hospital name; patient's name, age, sex; total days of stay, diagnoses; treatment prescribed; surgical procedures; attending and admitting physicians names; review results; name of person reviewed, review findings, and dates of findings.
Notes
A permanent retention was originally listed for this series. This retention was requested by the State Records Committee and not the agency. The agency had requested a three-year retention based on records at the Denver Medicaid regional office. In 2009, the analyst discovered reports summarizing the files and decided to create a separate, permanent series for the reports and to keep the original files for 12 years.