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Noncoverage forms, or information from other source used by North State Medical <br /> Transport to treat patients or bill for services. <br /> b. The electronic claims records or other paper records of submission of actual claims <br /> to Medicare or other insurance companies. <br /> c. Any patient-specific claim and billing information, including responses from <br /> insurance payers, such as remittance advice statements, Explanation of Medicare <br /> Benefits (EOMBs), charge screens, patient account statements, and signature <br /> authorization and agreement to pay documents. <br /> d. Notices from insurance companies indicating coverage determinations, <br /> documentation submitted by the patient, and copies of the patient's insurance card <br /> or policy coverage summary,that relate directly to the care of the patient or <br /> payment for that care. <br /> e. Amendments to PHI, or statements of disagreement by the patient requesting the <br /> amendment when PHI is not amended upon request, or an accurate summary of the <br /> statement of disagreement. <br /> 2. The DRS should also include treatment related records created by other parties such as <br /> first responder units, assisting ambulance services, air medical services, nursing homes, <br /> hospitals, police departments, coroner's offices, etc.,that are used by North State <br /> Medical Transport for treatment and payment related purposes. <br /> 3. A designated record set should not include: <br /> a. Quality assurance data collected and maintained for peer review purposes; <br /> b. Accident reports; <br /> c. Incident reports; <br /> d. Duplicate information maintained in other systems; <br /> e. Data collected and maintained for research; <br /> f. Information compiled in reasonable anticipation of litigation or administrative F <br /> action; <br /> g. Employment records; or <br /> h. Student records. <br />