(General Information, Eligibility, and Entitlement Manual)

Disposition:  Destroy 3 months after the date of the response to the correspondence. If a response is not required, the contractor destroys the material 3 months after the date of the correspondence.   Where the material documents a specific claim, appeal, or similar case, the contractor  follows the instructions for claims records .  17. MAC Contract Files   These consist of agreements entered into with MACs by the Secretary under the provisions of 1816 and 1842 of the Act by which MACs agree to perform certa in functions in administering the Hospital Insurance and Supplementary Medical Insurance programs.  As such, they provide basic documentation of the manner in which these programs are implemented.  Included are modifications and amendments.  Disposition:  Destroy 3 years after supersession or termination, as applicable.  18. MAC Subcontract Files   These consist of copies of MAC agreements with subcontractors regarding performance of an audit of providers' costs A/B MAC (A) or (HHH), leases for building spac e, equipment, and consulting and other services.  Included are CMS approvals, amendments, and similar papers.   Disposition:  Destroy 3 years after termination of agreement.   19. Contract Performance Review Visit Files   These consist of documents relating to scheduled or special visits to Medicare contractors to review your Medicare operations, to determine the degree of adherence to established policy and adequacy of service to the public, and to verify the accuracy of reporting.  Included are reports of staff visits, follow -up reports, communications concerning improvements in operations, and any other related documents.   Disposition:  Destroy 4 years after the close of the calendar year in which action on the review is completed.   20. MAC Computer Printou t Records (FROZEN -  DO NOT DESTROY)   These consist of computer printouts used in processing, paying, and controlling Medicare claims.   a. Pending and process listing, payment listing, duplicate check control, master file update control, and profiles of ph ysicians and other suppliers of services.   Disposition:  Once the freeze is lifted, destroy 4 years after the close of the calendar year in which payment was made.    b. Check listing and bank reconciliation.  Disposition:  Once the freeze is lifted, destro y 6 years after the close of the calendar year in which paid or voided.    c. CWF inquiry or response listings, transaction listing, activity listings, posting exceptions, analysis of posting errors, claims inventory control, edit input transactions, and aging of open claims.   Disposition:  Once the freeze is lifted, destroy 3 years after processing.  (Contractors with the capability of electronically retaining the CWF data may destroy the paper copies after the tapes have been verified.)   21. A/B MAC (A) or (HHH) Cost Report Files (FROZEN -  DO NOT DESTROY)   These consist of cost reports submitted by providers to A/B MACs (A) or (HHH)  for determining Medicare reimbursable costs in accordance with regulations and the principles of reimbursement.  The cost re port file includes: (a) a copy of the original cost report form as filed by the provider; (b) copies of all decisions made by field auditors, including those subsequently reversed by senior auditors; (c) a copy of the Audit Adjustment Report; (d) a copy of  revised cost report schedules (or a revised cost report); (e) a copy of the notice of program reimbursement; (f) a copy of the audit report when prepared by the A/B MAC (A) or (HHH) staff accountants and the supporting audit working papers.   Disposition:  The A/B MAC (A) or (HHH) maintains the cost report on premises for 3 years after the Notice of Amount of Medicare Program Reimbursement has been issued to the provider, and then transfers cost report to inactive storage.  Once the freeze is lifted, destro y the cost report files 5 years after receipt.   (Exception: A cost report file that is the subject of an appeal, litigation, or any other administrative proceedings, e.g., collection of outstanding overpayments or bankruptcies is not sent to inactive stora ge until the case has been settled or closed and all the review and appeal procedures have been exhausted.)   22. MAC Closing Agreements   These files contain the accepted final settlement for all MAC costs of administration and consist of the closing agreement, appendix, and schedules of balances due the MAC or Secretary.   Disposition:  The MAC cuts off files at the end of the fiscal year.  It holds the file in office 1 year after HHS audit and final settlement then transfers to inactive storage.  Destroy these 10 years after HHS audit and final settlement.   23. Medicare Data Match Files (FROZEN -  DO NOT DESTROY)   Questionnaires, case files, employer records and data match records.   Disposition:  Cutoff files at the end of the calendar month and transfe r to an offsite storage facility.  Once the freeze is lifted, destroy 6 years and 3 months after cutoff.   24. Initial Enrollment Questionnaire (FROZEN -  DO NOT DESTROY)   Questionnaires sent to newly enrolled Medicare beneficiaries to obtain information on whether the individual is covered under a primary insurance plan.   Disposition:  Once the freeze is lifted, destroy/delete when 5 years old.   25. Provider Statistical and Reimbursement Reports (PS&RR) - (FROZEN -  DO NOT DESTROY)   These files consist of EDP  printouts or microforms showing summaries of payments to hospitals, skilled nursing facilities, home health agencies, and other providers of service.  They are used to effect cost settlements between the A/B MACs (A) or (HHH) and the providers for program  validation purposes and to determine accuracy of cost reports.  These reports contain Part A and Part B inpatient and outpatient information, inpatient statistics, total bills, covered costs, and other related data.   Disposition:  Once the freeze is lifte d, destroy 5 years after completion of audit and/or settlement process for provider cost report for corresponding fiscal year.   26. A/B MAC (B) or DME MAC Claims Processing File  Consists of documents relating to Part B A/B MAC (B) or DME MAC performance.  Submitted on a weekly basis electronically to CMSs data center.   Disposition: Destroy after 6 months.   30.40 - Retention of Claims File Materials  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  After the claims determination p ayment action and posting to CMS records is completed, the bills and related materials are accumulated in file segments and held before transfer to an approved offsite storage facility (see 30.40.2).  Claims records having current value and continuing ref erence, or claims records otherwise flagged to indicate pending action, are retained as long as the A/B MAC (B) or DME MAC finds necessary.   30.40.1 - Segment File Accumulation Period  (Rev. 124, Issued: 05- 17-19, Effective: 06- 18-19, Implementation: 06- 18-19  The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary's Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Me dicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that will continue to use the HICN as part of their processes.   In order to facilitate the transfer of material to an approved offsite s torage facility, MACs maintain the permanent claims records files in accumulation period segments, based on the starting date of initial payment or denial.  Each contractor may select an accumulation period segment of from 6 months to 2 years in length aft er such starting date.  The contractor may also adopt one period of time on an ongoing basis, but a different period for the initial segment.   Contractors who have been authorized to microfilm/image claims records may be authorized to shorten the segment f ile accumulation period.  (See 30.50 .)  After a file segment is closed, the contractor retains the records contained in that segment until time to transfer them to an approved storage facility.  (See  30.40.2 and 30.40.3  for definition of retention periods.)   EXCEPTION:   Contractors who maintain total history files by individual Medicare beneficiary identifier , name, or other sequence, may wish to operate under some procedure other than by a file segment accumulation period.  Such alternative procedures may be used provided purging techniques to withdraw inactive records are established which meet one of the following requirements:   1.  They avoid costly and time cons uming manual selection of material to be purged from each folder.   2.  Separators are used for each year's (or other period's) material within the history folder to facilitate rapid selection.   3.  The capability exists (e.g., computer prepared lists) to i dentify inactive cases in which no action has been taken for 12 months or more for selection as purged segments to be transferred to an approved storage facility when such a purge becomes necessary.   4.  Periods for purging and transfer are carefully selec ted by studying rates of reference to claims materials in order to select a realistic inactive period to avoid unnecessary recall from the storage facility.   Although contractors who follow a purging procedure need not establish a standard retention period, the establishment of one of these requirements provides them with the potential of transferring inactive files to a storage facility if such a transfer should become desirable.  When such a purge is begun, the contractor should make no transfer to the st orage facility until the entire purging operation for the period is completed. 30.40.2 - Standard Retention Periods - Microfilmed Claims  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Contractors keep each permanent claims reco rds file segment for a period of not less than 6 months or more than 1 1/2 years after the segment has been closed.  The contractor bases the selection of a retention period on its experience with the rate and frequency of reference and other criteria. It also should avoid too early transfer to the storage facility, which could result in volume recalls and delays.  The contractor bases the exact length of the retention period on its needs and on the arrangements worked out with the storage facility.   The fo llowing examples of segment accumulation and retention periods demonstrate some of the ways in which these periods can vary.   EXAMPLES:  Segment Files   Accumulation Period  Retention Period Transfer  a. 6 months     7/1/05 -  12/31/05  6 months  7/1/06  1/1/06 -  6/30/06  6 months  1/1/07  1/1/06 -  6/30/06  12 months  7/1/06  1/1/06 -  6/30/06  18 months  1/1/07 b. 9 months     7/1/05 -  3/31/06  6 months  10/1/06  7/1/05 -  3/31/06  12 months  4/1/07  7/1/05 -  3/31/06  18 months  10/1/07 c. 12 months     1/1/05 -  12/31/05  6 months  7/1/06  1/1/05 -  12/31/05  12 months  1/1/07  1/1/05 -  12/31/05  18 months  7/1/07 d. 18 months     1/1/05 -  6/30/07  6 months  1/1/08  1/1/05 -  6/30/07  12 months  7/1/08  1/1/05 -  6/30/07  18 months  1/1/09 Accumulation Period  Retention Period Transfer  e. 2 years     7/1/05 -  6/30/07  6 months  1/1/08  7/1/05 -  6/30/07  12 months  7/1/07  7/1/05 -  6/30/07  18 months  1/1/09  30.40.3 - Retention Period - Microfilmed Material  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)