CP6
Record-Keeping
CMS-required outcome
The system tracks each claim throughout the adjudication process (including logging edits made to the claim) and retains transaction history to support claims processing, reporting, appeals, audits, and other uses.
Default metrics
- Records must be retained for a minimum of 3 years for fiscal records, 5 years for records related to cost reports, 6 years for medical records of covered entities, and 10 years for managed care records (or greater if required under State laws) – periods are measured from the date of closure of all related actions for a given record.
- Pass/Fail that the state can demonstrate that 100% of records were retained for the appropriate number of years indicated above.
Regulatory sources
- 42 CFR 447.45
- 42 CFR 431.17
- SMM Part 11 Section 11325