(General Information, Eligibility, and Entitlement Manual)

30.30.2 - Description of Records (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.   1. Medicare Clai ms Records:   A. A/B MAC (A) or (HHH) Billing Records ( FROZEN -  DO NOT DESTROY)   These files consist of Inpatient and/or Outpatient Billing forms, and other documents used to bill for services processed by A/B MACs (A) or (HHH)  i.e., inpatient hospital, outpatient hospital, SNF, hospice, home health, etc.  DISPOSITION:  Once the freeze is lifted, cutoff at the close of the CY in which paid.  Destroy 6 years and 3 months after cutoff.   B. A/B MAC (B) or DME MAC Billing Records (FROZEN -  DO NOT DESTROY)   These files consist of Requests for Payment and similar forms.  Also included are itemized bills, correspondence (including correspondence with district offices), and comparable documents used to support payment to beneficiaries, physicians, and other suppliers  of services under the Supplemental Medical Insurance (SMI) Program.   DISPOSITION:  Once the freeze is lifted, cutoff at the close of the CY in which paid.  Destroy 6 years and 3 months after cutoff.   2. Medicare Benefit Check Records (FROZEN - DO NOT DEST ROY)   These files consist of paid checks that contractors receive from banks covering amounts paid to providers of service, beneficiaries, physicians, and other suppliers of service under the Hospital Insurance and Supplementary Medical Insurance (SMI) pro grams.  Also included are check vouchers and cancelled or voided checks resulting from nonreceipt, loss, theft, or non- delivery.   Disposition:  The contractor cuts off the file at the close of the calendar year in which issued, holds the file for 1 additional year, and then transfers it to inactive storage.  Once the freeze is lifted, the file is destroyed after a total of 6 years and 3 months retention.  When fraud or overutilization of services is involved, the contractor retains the hard copy claim until 3 months after the resolution of the investigation OR reverts to normal disposition, whichever is longer.   3. Medicare Summary Notices (MSNs) (FROZEN -  DO NOT DESTROY)   These files consist of MSNs used to advise beneficiaries about remaining Part A benefi ts, Part A and Part B deductible status, and about applying for complementary health benefits.   Disposition:   The contractor cuts off the file at the close of the calendar year in which benefit was paid or denied, as applicable, holds for 1 additional year  and then transfers to inactive storage.  Once the freeze is lifted, remove them from inactive storage for destruction after a total of 6 years and 3 months retention from cut off.   4. Reconsideration and Hearing Case Files -  Hospital Insurance Program (FROZEN - DO NOT DESTROY)   Reconsideration records accumulate when a beneficiary or their representative is dissatisfied with the A/B MAC (A) or (HHH)'s determination denying payment, or with the amount of benefits payable on the beneficiary's behalf under  the Hospital Insurance Program and files either an expressed or implied request for reconsideration.  Hearing case records accumulate when a beneficiary or their representative is dissatisfied with the reconsideration determination and requests a hearing;  and if still dissatisfied after the hearing, files for a subsequent court review. Included are Forms CMS -2649, Request for Hearing; CMS -561, Request for Reconsideration; or their equivalents.  Also included are evidence furnished by beneficiaries or their  representatives, correspondence, CMS determinations, Administrative Law Judge decisions, original bills, Appeals Council decisions and similar material.   Disposition:   Once the freeze is lifted, the contractor disposes of these records in accordance with instructions for Medicare claims records .  5. Review and Fair Hearing Case Files - Supplementary Medical Insurance Program (FROZEN -  DO NOT DESTROY)   This category includes files accumulated when a beneficiary, physician, prov ider, or other supplier of service is dissatisfied with the MACs determination denying a request for payment, or with the amount of the payment, or with the reasonable promptness of action on a request for payment.  Included are copies of claimant's reque sts for review, relevant written statements or evidence, notices of adverse formal review decisions, requests for hearings to protest the adverse decisions, hearings proceedings, hearing officers' final decisions, and other comparable papers.  Disposition:   The contractor places these records in an  inactive file upon final action on the case.  It cuts off the inactive file at the close of the calendar year in which the final action was taken, and holds it for 2 additional years, then transfers it to off -site storage.  Once the freeze is lifted, these records can be destroyed when 5 years old.   6. A/B MACs (A) and (HHH) and A/B MAC (B) or DME MAC Administrative Budget Estimate and Cost Report Form (FROZEN -  DO NOT DESTROY)   These files consist of all uses of the Administrative Cost and Budget Report, CMS -1523 for A/B MAC (B) or DME MAC and CMS -1524 for A/B MACs (A) or (HHH).  This form is a multi -use document and issued for budget and cost reporting activities.  Specific uses are:   a. Budget request, supplemental budget request, notice of budget approval, interim expenditure report.   Disposition:  Once the freeze is lifted, destroy after a total retention of 3 years after HHS audit and final settlement.   b. Supplemental Budget Request   Disposition:  Once the freeze is lifted, destroy after a total retention of 3 years after HHS audit and final settlement.   c. Notice of Budget Approval.  The MACs certified funding authority for the fiscal year.  Include all supporting schedules, correspondence and justification.  Disposition:  Once the freeze is lifted, destroy after a total retention of 3 years after HHS audit and final settlement.   d. Interim Expenditure Report.  Cumulative fiscal year to date expenditures incurred by the MAC.  Include all supporting schedule s, correspondence and justifications.  Disposition:  Once the freeze is lifted, destroy after a total retention of 3 years after HHS audit and final settlement.   e. Final Administrative Cost Proposal.  The final statement of expenditures for the fiscal year.  This form is used as the basis for final settlement of allowable costs.  Include all supporting schedules, correspondence, HHS or GAO audit reports on administrative cost and benefits payments.  Disposition:  Once the freeze is lifted, destroy after a total retention of 6 years and 3 months after HHS audit and final settlement.   7. MAC Letter of Credit Files (FROZEN - DO NOT DESTROY)   These records are authorizations to a Federal Reserve Bank to disburse funds to designated MACs banks on behalf of CMS upon presentation of request for funds for collection through the Federal Reserve System.  Included are Standard Form 1193, Letter of Credit or its equivalent, and amending letters.   Disposition:  Once the freeze is lifted, destroy after a total retention of 6 years and 3 months after the year in which the letters of credit are cancelled.   8. A/B MAC (A) or (HHH)  Payment Vouchers and Transmittal Files (FROZEN -  DO NOT DESTROY)   These consist of Form TFS -218, Request for Funds, and similar documents prepared by the A/B MAC (A) or (HHH) s servicing bank to obtain Federal funds for benefits paid in administering medical insurance programs.  Also included is Form CMS -1521, Payment Voucher on Letter of Credit, a transmittal that forwards information on request for funds to CMS and shows the purpose for which funds were drawn, i.e., hospital insurance benefits, supplementary medical insurance benefits, and total amount of payment vouche rs.  Disposition:  Once the freeze is lifted, destroy after a total retention of 6 years and 3 months or after HHS audit and final settlement, whichever is later.   9. A/B MAC or DME MAC Payment Vouchers and Transmittal Files (FROZEN -  DO NOT DESTROY)   Thes e files consist of form TSF -5805, Request for Funds, and similar documents prepared by the A/B MAC (B) or DME MACs servicing bank to obtain Federal funds for benefits paid in administering medical insurance benefit programs.  Also included is Form CMS -1521, Payment Voucher on Letter of Credit Transmittal, a transmittal that forwards information on request for funds to CMS and shows the purpose for which funds were drawn, i.e., SMI benefits and total amount of payment vouchers.   Disposition:  Once the freez e is lifted, destroy after a total retention of 6 years and 3 months or HHS audit and final settlement, whichever is later.   10. A/BMAC (A) or (HHH) Monthly Financial Report Files   These are reports submitted monthly to provide CMS with the basic data to r econcile CMS's accounts with those that contractors maintain.  Included are Form CMS -1522, Monthly Intermediary Financial Report and attachments.   Disposition:  Destroy after HHS audit and final settlement.   11. A/B MAC (B) or DME MAC Performance Report Files   These consist of Forms CMS -1565, Health Insurance for the Aged Program Carrier Performance Reports, and equivalent documents prepared monthly summarizing each A/B MAC (B) or DME MACs performance in processing claims.  The information provides manag ement information needed for budgeting, financing, work planning, performance evaluation, and identifying operating problems.   Disposition:  Destroy after 3 years.   12. Ambulance Supplier Certification Files   These consist of certifications of suppliers of  ambulance services.   Disposition:  Destroy 1 year from the end of the year when certification requirements are no longer met.   13. Requests for Assistance from District Offices (DOs) (FROZEN -  DO NOT DESTROY)   These consist of correspondence and forms submitted to the DO for development of additional information or documents relating to a Medicare claim, e.g., incorrect name or Medicare beneficiary identifier and similar errors that prevent the processing of a claim.   Disposition:  Once the freeze is lifted, dispose of in accordance with instructions for claims records .  14. A/B MAC (A) or (HHH) Workload Reports Files   These consist of monthly statistical reports on the status of A/B MAC (A ) or (HHH) workloads used by CMS to identify basic management data needed for budgeting, financing, work planning, and progress evaluation.  Included is Form CMS -1566, Health Insurance for the Aged Program FI Workload Report, or equivalent documents.  Disp osition:  Destroy after 3 years.   15. Overpayment and Duplicate Charge Detection Activity Report Files -  A/B MAC (B) or DME MAC Report   These consist of quarterly reports summarizing overpayment and duplicate charge detection activity.  They are used to tabulate data on the number of cases in which overpayments are recovered, the total dollar amount of money overpaid, causes of overpayments, number of duplicated charges detected, and similar information.  Disposition:  Destroy after 3 years.   16. Medicare Beneficiary Correspondence Files (FROZEN -  DO NOT DESTROY)  These accumulate as a result of inquiries and complaints received by CO, RO, and contractors and do not  include any correspondence that is related to a claim file.   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