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					Division of Public Health Designated Record Sets Definition Covered Component: Local Health Services, HSIS Business Liason Used to Make DPH IIHI Decisions Record Owner Contact

Documentation Type Data Content

Purpose

Location Stored Media

Client Access

Comments

Billing Record

Patient Account Data: Patient-specific claim, remittance, statement of account balance, claim status, charge screen

Medicaid, Medicare, ThirdParty Insurance Billing for Healthcare Services

Yes No

Local Health Departments Development Evaluation Centers State Laboratory of Public Health

HSIS Business Liason

HSIS Software

Copy of paper report or paper copy of screen prinouts only

HSIS billing records can be a duplicate of records maintained by local health Via Request to department Healthcare software and/or Service other local health Provider (Local department Health Dept. or designated billing DEC). records

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Division of Public Health Designated Record Sets Definition Covered Component: Women's and Children's Health, Children's Special Health Services Used to Make DPH IIHI Decisions Record Owner Contact

Documentation Type Data Content
Authorization Number for Approvals, Service Approved/Denied, Additional Information Required to Process, if applicable, Reason for Denial, Patient's Medicaid and/or insurance information.

Purpose

Location Stored Media

Client Access

Prior Approval

To communicate decision regarding medical necessity for Medicaid reimbursement of mobility devices. Yes Yes

Children's Special Health Services and Office of Controller Purchase of Spruill Purchase of Care Medical Care Annex

Via Provider. Authorization Request Hardcopy includes printed names/addres from ses of Purchase providers who of Medical receive copy of Services approved system authorization

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Comments

CSHS/POMC do not create original IIHI. Source medical documentation from medical providers is used to determine medical necessity.

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Division of Public Health Designated Record Sets Definition Covered Component: State Laboratory for Public Health Used to Make DPH IIHI Decisions Record Owner Contact

Documentation Type Data Content

Purpose

Location Stored Media

Client Access

Lab Test Results

Results from specimans submitted to lab from medical providers and other laboratories.

To substantiate presence of medical conditions.

Yes No

Authorized submitter of speciman for testing (e.g., Local Health Departments, Medical Providers) and State Laboratory of Public Health

State Laboratory Quality Assurance

Via Request to Healthcare Service Provider (Local Health Dept. or DEC) Acccess to DSR for State Laboratory of Public is provided only to "authorized" submitter of laboratory test (e.g., healtchare Laboratory providers) per Information Paper or CLIA and NC Managemen electronic Administrative t System lab report Code.

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Comments

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posted:11/8/2009
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