Antoinette-
The Designated Record Set for an individual includes the following:
1. Medical record charts in paper format
2. X-rays and other radiological test results
3. Medical records in electronic format.
4. Billing records in paper format.
5. Billing records in electronic format.
6. Medical information transmitted during the delivery of health care
via telemedicine as defined in C.R.S. 12-36-106(1)(g).
The following types of records are not used to make decisions about an
individual and are therefore excluded from the definition of Designated
Record Set:
1. Quality Assurance/Improvement records.
2. Peer review records.
3. Records of medical appeals.
4. Records held by Hospital's Business Associates.
In most practices, claims adjudication information is housed in the
patient's electronic (or paper) billing record, and therefore would be
considered a part of the designated record set. At least, according to
the attorneys who prepared the above list. I haven't found anything
that contradicts this information. If anyone else has, please let me
know.
Hope this helps.
Kelli Knuckles
Mesa County DHS
>>> "Croly, Antoinette" <[EMAIL PROTECTED]> 09/25/02 02:57PM
>>>
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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