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Tennessee Secretary of State Tre Hargett
Records Management Division
RDA
RDA Management System
RDA Details
RDA
RDA: 11264
Database ID: 2344
Record Series Title: Forensic Billing And Determination Files
Record Series Abstract: Records Include But Are Not Limited To: Copies Of Patient's Medical Records For Forensics. Including Form Titles: Final RMHI 301(A)Forensic Team Meeting Staff Conference Progress Note, Inpatient Forensic Data Report, Forensic Discharge Summary, Office Of Forensic & Juvenile Court Services Payment Summary/Authorization Program:400129-Inpatient Services, For Reimbursement.
Record Series Active: Yes
Cut Off at End of: Fiscal Year
If Other, Explain:
Total Retention: 5 Years 0 Months
Retention End Action: Destroy
Disposition Notes: Once a determination is made by outpatient third-party facility or inpatient state-owned facility, case file is sent to agency for billing purposes. These records are kept separate from the patient medical record. Record Is Generated Maintained In Paper And Electronic format. Paper Records Can Be Destroyed Once Scanned And Verified For Completeness And Accuracy. Maintain By Fiscal Year And Destroy After 5 Years via state approved methods. Copies of Patient Medical Record included in determination file may be destroyed once of no further administrative use.
View Signed Form: Form Not Received
Worksheet
Worksheet ID: 2343
Record Location: 500 DEADERICK ST, AJB 5th FLOOR, DIV OF PLANNING, RESEARCH & FORENSICS #5.130
File Arrangement: ALPHA
Media Format Generated: Both
Media Format Stored: Paper/Electronic
Date Range: 7/1/15 TO CURRENT
Annual Accumulation: 12 CU. FT. 240 GIGABYTES
Current Volume: 24 CU. FT. 1200 GIGABYTES
Record Value: Administrative
Audit Requirements: State
Reference Frequency:
Current Year per Month: 21
Past Year: 0
2 - 5 Years: 0
Over 5 Years: 0
Data Update Frequency: Daily
Information Shared Outside of State: No
If Shared, List Agencies:
Essential Record: Yes - Duplicate
Essential Record Stored: REGIONAL MENTAL HEALTH INSTITUTES @ NASHVILLE, CHATTANOOGA, BOLIVAR, MEMPHIS
Essential Record Media Type: Paper
Confidential: Yes
Confidential Legal Citation: TCA 10-7-504
Media Recommendation: Current Format
Media Recommendation Other:
Agency Retention: 5 FISCAL YEARS
Agency Retention - Years Active: 1
Agency Retention - Years Inactive: 4
Records Center Retention Period: 0
Final Disposition after Retention Expires: Destroy
Legal Citation: TCA 10-7-504
Record Sample: No Sample
Legal Documentation: No Legal Documentation
Electronic Records Plan Inventory
System Name: ORACLE FILE SERVERS
IT-ABC Number: N/A
Hardware Description: THE ELECTRONIC RECORDS ARE STORED IN FOLDERS ON A STRATEGIC TECHNOLOGY SOLUTIONS (STS) SERVER. ALL HARDWARE FOR MAINTAINING THE RECORD SERIES SHALL BE MAINTAINED IN ACCORDANCE WITH THE CURRENT STANDARDS OF STS.
Software Description: DOCUMENTS AND METADATA ARE CAPTURED BY USING MULTI-FUNCTION DEVICES AND SCANNING THE DOCUMENT BY PRESSING THE APPROPRIATE BUTTON ON THE MULTI-FUNCTION DEVICE USING LEXMARK DOCUMENT DISTRIBUTOR SOFTWARE.
System Location: THE ELECTRONIC RECORDS ARE KEPT ON A SERVER MAINTAINED AND SUPPORTED BY STS AT THEIR DATA CENTER, 901 5th AVE N, NASHVILLE, TN. 37243.
Backup Procedures: BACKUP PROCEDURES SHALL BE MAINTAINED IN ACCORDANCE WITH THE CURRENT STANDARDS OF STS, LOCATED IN THE 901 5th AVE N, STS BUILDING, NASHVILLE, TN. 37243. BACKUP PROCEDURES SHALL BE REVIEWED AND TESTED ANNUALLY.
Disaster Recovery: THE AGENCY SHALL HAVE A DETAILED DISASTER RECOVERY PLAN FOR THE SYSTEM IN ACCORDANCE WITH THE CURRENT STANDARDS OF STS. THE DISASTER RECOVERY PLANS SHALL BE REVIEWED ANNUALLY.
Data Migration Description: DOCUMENTS ARE SCANNED TO THE STATE NETWORK TO A FOLDER ON A STS SERVER. THE METADATA CAPTURED AT THE TIME OF SCAN IS STORED IN A MICROSOFT SQL SERVER DATABASE AND IS DELETED AT THE 10 YEAR RETENTION DISPOSITION.
Metadata Description: METADATA VARIES BASED ON THE DOCUMENT TYPE. BELOW IS A LIST OF SOME DATA ELEMENTS; PATIENT'S FIRST NAME, MIDDLE INITIAL, LAST NAME, SOCIAL SECURITY NUMBER, ADDRESS, TRACKING NUMBER, DOCUMENT GROUP, DOCUMENT TYPE, COUNTY, DISTRICT, FILENAME, TOTAL PAGES, FILE SIZE, AUDIT ELEMENTS SUCH AS TRACKING NUMBER, VARIED BY, DATE CREATED, ACTIVE, CLOSED, PENDING, DELETED, ETC. THE DATA SETS ARE, BUT NOT LIMITED TO, EXCEL, WORD, TEXT, PDF, PICTURES, IMAGE FILES (TIFF ETC.) AND EMAIL EXPORTS. ANY ELECTRONIC FILE THAT IS RELEVANT TO PATIENT MEDICAL RECORD FILES WILL BE IN THE FOLDER STRUCTURE.
Contact Information
Contact Name: CATHY J BENHAMED
Job Title: PROCUREMENT OFFICER (RECORDS OFFICER)
Address 1: 500 DEADERICK ST
Address 2:
City: NASHVILLE
Zip: 37243
Phone: 615-532-6623
Email: Cathy.Benhamed@tn.gov
Agency: Dept. of Mental Health
Agency Head: MARIE WILLIAMS
Director: JAY OZIMINSKI
Allotment Code: 33901
Status
Action Requested: New RDA
Comments
  Date Comments
Records Management Division (RMD): 03-22-2018 No recommended changes, agency updated audit requirement.
Tennessee State Libary and Archives: 03-26-2018 No recommended changes.
Comptroller Audit Review: 2018-03-22 We have reviewed RDA 11264 from an audit standpoint. Please set the audit requirements to "state" or “both”.
Agency: 03-28-2018 Thank you.
RMD Director Recomendations: 04-03-2018 RDA 11264 is a request to create an RDA. The retention period will be five years and destroy. The format will be paper/electronic. Recommend approval of request to create RDA 11264.
Signed Form Received: 2018-04-03
PRC Meeting Date: 04-25-2018
PRC Comments: PRC approves RDA 11264.
PRC Action: Approved
RDA History
ID RDA PRC Reviewed PRC Action
2344 11264 2018-04-25 Approved