(General Information, Eligibility, and Entitlement Manual)

General Information, Eligibility, and Entitlement Manual  Chapter 7 - Contract Administrative Requirements   Table of Contents  (Rev. 128, 11- 01-19)  Transmittals for Chapter 7  10 - Contracting and Subcontracting  Not yet available  20 - Publishing by Contractors and Restrictions on Promotional Activity  Not yet available  30 - Files Maintenance  30.10 -  Files Maintenance Program -  General  30.10.1 -  Description of Records Maintained  30.10.2 -  Definition of a Record  30.20 -  Implementing a Files Management Program 30.30 -  Record Retention and Disposal Schedule  30.30.1 -  Disposition Instructions - Destruction of Records  30.30.1.1 -  Disposition Instructions When Operating Under a Free ze 30.30.1.2 -  Disposition Instructions When Medicare Records are Microfilmed  30.30.1.3 -  Disposition for Paper -Only Medicare Records  30.30.1.4 -  Disposition for Medicare Records that are Imaged/Scanned  30.30.1.5 -  Disposition for Medicare Records When Potential Fraud or Overutilization has been Identified  30.30.2 -  Description of Records  30.40 -  Retention of Claims File Materials  30.40.1 -  Segment File Accumulation Period  30.40.2 -  Standard Retention Periods -  Microfilmed Claims  30.40.3 -  Reten tion Period Microfilmed Material  30.50 -  Microfilming of Files Material  30.50.1 -  Microfilming Procedures  30.50.2 -  Microfilming Index Label  30.50.3 -  Retention and Destruction of Microfilm  30.60 -  Annual Report of Medicare Records  30.70 -  Disposition of Non- Claims Materials  30.80 -  Standards for All Records Storage  Facilities  30.90 -  Exhibits  Exhibit 1 -  Preprinted Container Label  Exhibit 2 -  Minimum Label Data Required for Unlabeled Boxes  Exhibit 3 -  Records Transmittal and Receipt -  Standard Form 135 Exhibit 4 -  Reference Request -  Federal Records Center -  Optional Form 11  Exhibit 5 -  Certificate of Authenticity -  START  Exhibit 6 -  Certificate of Authenticity -  END  Exhibit 7 -  Correction Card  Exhibit 8 -  Start of Retake or Addition Certificate  Exhibit 9 -  Retake or Addition Certificate  Exhibit 10 -  Resolution Test Chart  Exhibit 11 -  Witness Disposal Certification (Sample)  Exhibit 12 -  Roll Report  Exhibit 13 -  Report of Medicare Records  Exhibit 14 -  Inspection Checklist --Standards for Records Storage Facilities  40  Shared System Maintainer, Part A/Part B (A/B)/Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) and the Single Testing Contractor (STC) Responsibilities for System Releases  40.1 -  Standardized Terminology f or Claims Processing Systems  40.1.1 -  Standard Terminology Chart  40.2 -  Release Software  40.2.1 -  Implementing Validated Workarounds for Shared System Claims Processing by Al l Medicare Contractors  40.3  Shared System Testing Requirements for Shared System Maintainers, Single Testing Contractor (STC)/Beta Testers, and Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare Administrative Contract ors (MACs) 40.3.1 -  Shared System Testing Requirements for Shared System Maintainers, Single Testing Contractor (STC), and DME MACs  40.3.2  Minimum Testing Standards for Shared System Maintainers and the Single Testing Contractor (STC)/Beta Tester  40.3.3 -  Testing Standards Applicable to all Beta Testers  40.3.4 -  Testing Requirements Applicable to the CWF Beta Tester  40.3.5  Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare  Administrative Contractor (MAC) (User) and the Single Testing Contractor (STC) Testing Requirement s 40.3.6 -  Testing Requirements Applicable to all CWF Data Centers (Hosts)  40.3.7 -  Timeframe Requirements for all Testing Entities  40.3.8 -  Testing Documentation Requirements  40.3.9 -  Definitions  40.3.10 -  Test Case Specification Standard  40.3.11 -  Single Testing Contractor (STC) Non -Testable Conditions and Potential                 Testing Impacts    40.3.12  Next Generation Desktop (NGD) Requi rements                                                                  50 - Contractor Implementation of Change Requests and Compliance with Technical Direction Letters  50.1 -  CR Implementation Report (CRI R) Template  50.2 -  TDL Compliance Report (TCR) Template  50.3 -  Sample Cover Letter/Attestation Statement 50.4 -  Change Request (CR) Definitions  50.4.1 -  Issue Date  50.4.2 -  Implementation Date  50.4.3 -  Effective Date  50.4.4 -  Date of Service  60 - Procedures for Modifying Shared System Edits and Capturing Audit Trail Data  60.1 -  CMS Standard File for Reason Codes  70 - Change Management Process (Electronic Change Information Management Portal)  80  Fee -For-Service Contractor Workload Transitions  80.1  Transition Handbooks  90 - IDR Claims Sourcing from Shared Systems   30 - Files Maintenance  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06-26-06)  30.10 - Files Maintenance Program - General  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Subject to the provisions of the Code of Federal Regulations, Title 41, Part 102 -  Creation, Maintenance and Use of Records, http://www.access.gpo.gov/nara/cfr/waisidx_05/41cfr102-193_05.html  CMS has the responsibility for the development and implementation of standards and programs for the econom ical management of records under the health insurance program.  Specifically, CMS is required to provide for effective controls over the creation of records, including the making of records containing adequate and proper documentation of the contractor's administration and operations.  Each contractor is required to establish and maintain an active, continuing program for the economical and efficient management of the records outlined in 30.20 .  The contractor's programs must provide for:    Effective controls over the creation, the organization, maintenance and use, and disposition of all CMS health insurance claims and non -claims records; and    Development and application of standards, procedures, and techniques designed to assure the maintenance and security of records of continuing value and facilitate the disposal of all records of temporary value.   The contractor provides for the continued analysis and improvement of record classification and indexing systems, the use of filing equipment and supplies, and the reproduction and transportation of records.  The contractor assures that records are maintained economically and efficiently for maximum usefulness.   The files established by the contractor, and all records and procedures do cumenting its programs for controlling the creation, maintenance, and use of current records, for the selective retention of records of continuing value, and for the disposal of noncurrent records, must be available for periodic review by CMS.   Under no ci rcumstances are any records identified by CMS as relating to a current investigation or litigation/negotiation by the Office of the Inspector General or the Department of Justice, ongoing Workers Compensation, set aside arrangements, or documents which pr ompt suspicions of fraud and abuse of overutilization of services to be destroyed.  These records must be retained until you receive authorization from CMS.  30.10.1 - Description of Records Maintained  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Imple mentation: 06 -26-06)  A. Claims Records   These are Government records including Government -issued standard forms and other forms, documents, and statements needed to support claims.  Such records are maintained by the contractor in accordance with instruct ions regarding retention, transfer, destruction, and other disposition of claims materials.  (See 30.30 and 30.40 .)  B. Non -Claims Records   These include materials not needed as supporting documentati on of a claim, such as used work sheets, extra copies of documents, retained CMS bill copies where records were submitted on tape, used punched cards, EDP listings, used paper tape, and general correspondence not related to specific pending or processed cl aims.  See 30.30  for the records retention and disposal schedule and 30.70 for the disposition of such material.  C. Fiscal and Administrative Records   These include records that are not included as claims or non- claims records.  See 30.70  for the records retention and disposal schedule.   D. Microform Records   This is a term used for any form containing micro -images (e.g., micro film, microfiche).  If records are microfilmed, the original records must still be retained.   E. Scanned/Imaged Records   This is a term used for any information that is recorded in a form that only a computer can process.  This is the preferred format when paper records are not retained.  The image becomes the official record/recordkeeping copy which must be retained in accordance with directives from CMS.   30.10.2 - Definition of a Record  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Records are basically files consisting of papers, folders, photographs, photographic copies, magnetic tapes, or other recorded information regardless of physical form or characteristics, accumulated or maintained in filing equipment, boxes, disks , CDs or shelves, and occupying office or storage space.  Stocks of publications and blank forms are not included in this definition.  30.20 - Implementing a Files Management Program  (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 Medicare 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.   Adequate records management controls over the creation of contract or files must insure that important policies and decision are adequately recorded, routine operational paper work is kept to a minimum, and the accumulation of unnecessary files is prevented.  Effective techniques in this area include the application of sy stems for the control of correspondence and forms, the minimizing of duplicate files, and the disposal without filing of transitory material that has no value for record purposes.  CMS expects each contractor to establish an appropriate program for the man agement of its files.  The following actions are generally basic to such a files management program.   A. Standardize classification and filing schemes to:   1. Achieve maximum uniformity and ease in maintaining and using program records;   2. Facilitate disposal of records in accordance with applicable records disposal schedules; and  3. Facilitate possible later consolidation of identical type files presently maintained at different locations.  B. Formally authorize official file locations.  Prohibit the  maintenance of files at other than authorized locations.  C. Standardize reference service procedures to facilitate the finding, charge -out, and refiling of records.   D. File accumulations of papers received at file locations on a daily basis.   E. Audit periodically a representative sample of the files for duplication, misclassification, or misfiles.  In addition to the above, the contractor's program must:   1. Establish and implement standards and procedures issued by CMS.  Such CMS standards and procedures relate to:   a. Classifying, indexing, and filing records;   b. Providing reference services to filed records;   c. Locating active files to facilitate use of the records; and   d. Reviewing the program periodically to determine the adequacy of the system and its effectiveness in meeting requests.   2. Ensure that the standards, guides, and instructions developed for the files management program are readily available to all employees concerned with the files operations.  In addition, give pertinent information for user s of files and references services the widest possible dissemination.   3. File accumulations of papers received at file locations on a daily basis.   4. Audit periodically a representative sample of the files for duplications, misclassification, or misfiles.