7 AAC 43.030. Requirements for provider records

(a) A provider shall maintain accurate financial, clinical, and other records necessary to support the care and services for which payment is requested. The provider is responsible to assure that the provider's designated billing service, or other entity responsible for the maintenance of financial, clinical, and other records, meets the requirements of this section.

(b) A provider's record must identify patient information including

(1) recipient receiving treatment;

(2) specific services provided;

(3) extent of each service provided;

(4) date on which each service is provided; and

(5) individual who provided each service.

(1) the date of service and charge for each service provided;

(2) each payment source pursued;

(3) the date and amount of all debit and credit billing actions for each date of service provided; and

(4) the amounts billed and paid.

(d) A provider shall maintain a clinical record, including a record of therapeutic services, according to professional standards applicable to the provider, applicable state and federal law, the applicable Alaska Medicaid Provider Billing Manual as of May 9, 1997, and any pertinent contracts. The clinical record maintained by the provider must have clinical information to

(1) identify the recipient's diagnosis;

(2) identify the medical need for each service;

(3) identify each service, prescription, supply, or plan of care prescribed by the provider, if applicable; and

(4) include annotated case notes, signed, dated, or initialed by the individual who provided the service, for each service delivered.

(e) A provider shall retain the financial, clinical, and other records of a patient for which services have been billed to the Medicaid program for at least seven years from the date the service is provided. The duty of the provider set out in this subsection applies to a provider even if the provider's business is sold or transferred, or is no longer operating. If a provider ceases business, the provider shall notify the division how Medicaid patient records can be accessed in the future.

(f) A provider who maintains all or part of the provider's records in an electronic format shall ensure that the data required to be maintained by this section is readily accessible as required under 7 AAC 43.032(a) .

History: Eff. 8/18/79, Register 71; readopt 8/7/96, Register 139; am 11/29/97, Register 144

Authority: AS 47.05.010

AS 47.07.040

AS 47.07.070

Editor's note: The Alaska Medicaid Provider Billing Manual may be obtained by contacting the Department of Health and Social Services, Division of Medical Assistance, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.

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