Ohio Admin. Code 4123-6-14.1 - Records to be retained by MCO
(A) An MCO shall retain records received from
providers and subcontractors that are utilized by the MCO to
develop electronic billings to the bureau. The MCO
shall retain any records obtained from the providers and subcontractors that
are utilized by the MCO to perform its medical management
functions,
or
to substantiate the delivery, value, necessity, and appropriateness of goods
and services provided to injured workers, and to
develop electronic billings to the bureau.
The
(1)
The MCO shall retain records relating to a claim
so long as the industrial commission and bureau of workers' compensation have
continuing jurisdiction over the claim pursuant to section
4123.52
of the Revised Code. For records that do not relate
to a specific claim, including but not limited to monthly bank statements,
monthly bank records and reconciliations, and monthly check registers, the MCO
shall also create, maintain, and retain for a period of seven years from the
date of the transaction records documenting transactions with the injured
worker, providers, and subcontractors.
(2)
The MCO shall
also create, maintain, and retain records documenting transactions with the
injured worker, providers, and subcontractors that do not relate to a specific
claim, including but not limited to monthly bank statements, monthly bank
records (e.g., deposit slips), account reconciliations and all supporting
documentation (e.g., monthly check registers, outstanding check lists, voided
transactions), and general and subsidiary ledger accounting records for a
period of seven years from the date of the transaction.
(B) The failure of an MCO to
create, maintain, and retain such records shall be sufficient cause for the
bureau to deny payment for goods or services, or for performance fees, or for
declaring overpaid previous payments made to the MCO, and may be cause for
decertification.
(C) As used in
this rule, "records" includes, but is not limited to, "record" and "electronic
record" as defined in rule
4125-1-02
of the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441
Prior Effective Dates: 01/15/1999, 01/01/2001, 09/01/2013
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(A) An MCO shall retain records received from providers and subcontractors that are utilized by the MCO to develop electronic billings to the bureau. The MCO shall retain any records obtained from the providers and subcontractors that are utilized by the MCO to perform its medical management functions, or to substantiate the delivery, value, necessity, and appropriateness of goods and services provided to injured workers, and to develop electronic billings to the bureau. The
(1) The MCO shall retain records relating to a claim so long as the industrial commission and bureau of workers' compensation have continuing jurisdiction over the claim pursuant to section 4123.52 of the Revised Code. For records that do not relate to a specific claim, including but not limited to monthly bank statements, monthly bank records and reconciliations, and monthly check registers, the MCO shall also create, maintain, and retain for a period of seven years from the date of the transaction records documenting transactions with the injured worker, providers, and subcontractors.
(2) The MCO shall also create, maintain, and retain records documenting transactions with the injured worker, providers, and subcontractors that do not relate to a specific claim, including but not limited to monthly bank statements, monthly bank records (e.g., deposit slips), account reconciliations and all supporting documentation (e.g., monthly check registers, outstanding check lists, voided transactions), and general and subsidiary ledger accounting records for a period of seven years from the date of the transaction.
(B) The failure of an MCO to create, maintain, and retain such records shall be sufficient cause for the bureau to deny payment for goods or services, or for performance fees, or for declaring overpaid previous payments made to the MCO , and may be cause for decertification.
(C) As used in this rule, "records" includes, but is not limited to, "record" and "electronic record" as defined in rule 4125-1-02 of the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441
Prior Effective Dates: 01/15/1999, 01/01/2001, 09/01/2013