We are looking for information specific to the development
of the Designated Record Set (DRS). We are a Medicaid MCO. The reg says
that claims adjudication is part of the DRS.
The definition of DRS includes information used to make
decisions made regarding members. We are trying to determine what
information we would have to give a member upon request for access to the
DRS.
Claims adjudication results are not used to make decisions
that effect the member. Federal law prohibits billing Medicaid recipients.
There is no interaction with members re: claims.
We are proposing that we consider not including payment or
claims adjudication information as part of our DRS. The fall back is to
include the diagnosis and procedure codes and rendering provider's name
in the DRS.
Any feedback would be appreciated.
Antoinette Croly
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