Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 1 - MEDICAID PROVIDERS AND SERVICES
Rule 1.4 - Program Integrity and Appeals
Section 1.4-2 - Medical records
Current through March 20, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-7-2-38; IC 12-13-7-3; IC 12-15-13.5-6; IC 12-15-22
Sec. 2.
(a) Medicaid records shall be:
(b) All providers shall maintain, for a period of seven (7) years from the date Medicaid services are provided to a member, medical or other records as are necessary to fully disclose and document the extent of the services provided. A copy of a claim form that has been submitted by the provider for reimbursement is not sufficient documentation, in and of itself, to comply with this requirement. Providers must maintain records that are independent of claims for reimbursement. Medical or other records, or both, shall include, at the minimum, the following information and documentation:
(c) Providers whose reimbursement is determined by the office shall maintain financial records for a period of not less than three (3) years following submission of financial data to the office. A provider shall disclose this financial data when the information is to be used during the rate determination process, as well as during audit proceedings.
(d) Records maintained by providers under subsections (a), (b), and (c) shall be subject to prepayment and postpayment review by the office and shall be openly and fully disclosed and produced to the office upon reasonable notice and request. A notice and request may be made in person, in writing, or orally. Failure on the part of a provider to comply with this section shall subject the provider to sanctions under IC 12-15-22 and applicable federal law.
(e) Services provided by a community mental health center (as defined in IC 12-7-2-38) as part of an ongoing plan of treatment or the documentation of specific treatment methods are subject to reporting requirements outlined in IC 12-15-13.5-6.