Record Keeping

Medicaid Provider Manual

SECTION 13 – RECORD KEEPING

13.1 RECORD RETENTION [CHANGE MADE 7/1/07]

Providers must maintain, in English and in a legible manner, written or electronic records necessary to fully disclose and document the extent of services provided to beneficiaries. Necessary records include fiscal and clinical records as discussed below. Appointment books and any logs are also considered a necessary record if the provider renders a service that is time-specific according to the procedure code billed. Examples of services that are time-specific are psychological testing (per hour), medical psychotherapy (20-30 minutes), and vision orthoptic treatment (30 minutes). The records are to be retained for a period of not less than seven (changed 7/1/07) years from the DOS, regardless of change in ownership or termination of participation in Medicaid for any reason. This requirement is also extended

to any subcontracted provider with which the provider has a business relationship.

13.2 PROVIDER'S ORDERS [CHANGE MADE 7/1/07]

Providers rendering or arranging services upon the written order of another provider (e.g., physician) must maintain that order for a period of seven (changed 7/1/07) years.

13.3 BENEFICIARY IDENTIFICATION INFORMATION

Providers must retain the following beneficiary identification information in their records:

	Name
	Medicaid ID number
	Medical record number
	Address, including zip code
	Birth date
	Telephone number, if available
	Any private health insurance information for the beneficiary, if available

13.4 AVAILABILITY OF RECORDS [CHANGE MADE 10/1/07]

Providers are required to permit MDCH personnel, or authorized agents, access to all information

concerning any services that may be covered by Medicaid. This access does not require an authorization from the beneficiary as it is considered part of the treatment, payment and operations processes that do not require authorization under the HIPAA Privacy rule. Health plans contracting with the MDCH must be permitted access to all information relating to services reimbursed by the health plan.

Providers must, upon request from authorized agents of the state or federal government, make available for examination and photocopying any record that must be maintained. (Failure to make requested copies available may result in the provider's suspension from Medicaid.) Records (exclusive of billings or charges) may only be released to other individuals if they have a release signed by the beneficiary authorizing access to his records.

Version General Information for Providers
Date: October 1, 2007 Page 30
Michigan Department of Community Health

Date: October 1, 2007 Page 30

Michigan Department of Community Health