Glossary September 2011

7/18/2019 Glossary September 2011

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GLOSSARY OF FREQUENTLY USED HEALTH CARE/PASSPOR

ACRONYMS AND TERMS

September 2011



PASSPORT GLOSSARY – September 2011

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GLOSSARY OF FREQUENTLY USED HEALTH CARE/PASSPORT ACRONYMS AND TERMS

277CA Healthcare Claim Acknowledgement (See X12 277CA)5010 ASC X12 version 5010 and NCPDP version D.0 (See ANSI X12 5010)999 Implementation Acknowledgement (See X12 999)A08 HL7 Update Patient Registration MessageAAA Abdominal Aortic AneurysmAAC Average Allowable Cost (EHR Technology)AAHAM American Association of Healthcare Administrative ManagementAAHP See AHIPA/B MAC Medicare Administrative Contractor (Replacement for Medicare FI/Carrier System)ABN Advance Beneficiary Notice of Non Coverage (ABN)ACA Affordable Care ActACE Access Control EntryACH Automated Clearing HouseACK Acknowledgement PacketACO Accountable Care OrganizationACPOE Ambulatory Computerized Physician Order EntryACROFILE Complete Consumer Credit Report (EQUIFAX)

ACF Administration for Families and ChildrenACS Automated Claims StatusACT Automated Collection Transactions (EFX Batch Credit Report)ADA American Dental AssociationADBS Automated Daily Batch SubmissionADE Adverse Drug EventADI Advanced Diagnostic ImagingADIC Ambulatory Diagnostic Imaging Center (Independent Radiology)ADR Additional Development/Documentation RequestADS Automated Development System (Medicare)ADT Admission Discharge & TransferAES Advanced Encryption StandardAF Administrative Fee

AFD Automated Fuel Transaction (Visa)AFDC Aid to Families With Dependent ChildrenAFN Accumulation File Number (Medicare)AHA American Hospital AssociationAHIC American Health information CommunityAHCA American Healthcare AssociationAHIMA American Health Information Management Association

AHIP America’s Health Insurance PlansAHRQ Agency for Healthcare Research & QualityAIS Atlantic Information ServicesAIU Adopt, Implement, Upgrade, (Certified EHR Technology)AJAX Asynchronous Java Script & XMLAKL Federal Anti-Kickback Legislation

ALF Assisted Living FacilityALJ Administrative Law JudgeALOS Average Length of StayAMA American Medical AssociationAMIA American Medical Informatics AssociationAMMF Acquirer Merchant Master File (VISA)AMP Access Management Platform




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ANSI American National Standards Institute – Approved standards developingorganization in Healthcare arena

ANSI X12 5010 Updated Version of the current 4010 Medical Transaction StandardAOB Assignment of BenefitsAOC Attestation of ComplianceAPC Ambulatory Payment ClassificationAPDRG All Patient Diagnostic Related GroupingAPG Ambulatory Patient Groups (See APC)API Application Programming InterfaceAP Asia Pacific (Visa) APP Anti-Phishing ProtectionAPTA American Physical Therapy AssociationA/P Accounts PayableA/R Accounts ReceivableARDEN Syntax Standard (sponsored by HL7) formal procedural language that represents medical

algorithms in clinical information systems as knowledge modulesARRA American Recovery and Reinvestment Act of 2009ASC Ambulatory Surgical CenterASCII American Standard Code For Information InterchangeASO Administrative Service Organization

ASCP American Society for Clinical PathologyASP Application Service ProviderASP.Net Web development tools offered by Microsoft Allows build of dynamic web SitesASR Automatic Speech Recognition ASTM American Society for Testing and MaterialsASV Authorized Scanning VendorATM Asynchronous Transfer ModeATP Ability To PayAUP Acceptable User PolicyAUTHORIZATION See Pre-certAV Address VerificationAVS Address Verification ServicesAWP Average Wholesale Price

AWV Annual Wellness VisitB2B Business to BusinessB2C Business to ConsumerBA Business AssociateBAA Business Associate AgreementBA/R Billing Accounts ReceivableBBA Balanced Budget Act of 1997BBG Byzantine Banking Gobbledygook (S. Bagwell)

BBRA Balanced Budget Refinement Act of 1999BCBS Blue Cross Blue ShieldBCP Business Continuity PlanningBI Billing InterfaceBI Business Intelligence

BIA Business Impact AnalysisBIN Bank Identification NumberBIOS Basic Input/Output System BIPA Benefits Improvement and Protection Act of 2000BNI Bankruptcy Navigator Index (EFX Add-on Product to Credit Report)BOC Back Office ConversionBS BatchSource (Passport Product Abbreviation)Carrier Insurance Company that administers Medicare Part B




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CAGR Compound Annual Growth RateCAH Critical Access HospitalCAHPS Consumer Assessment of Healthcare Providers and SystemsCAM Consumer Account MangementCAQH Council for Affordable Quality HealthcareCARC Claim Adjustment Reason CodeCAS Compliance Analyzer ServiceCAS Code Access SecurityCASS Coding Accuracy Support System (U.S. Postal Service Certification)CAT Computed Axial Tomography (see CT)CAT Client Admin ToolCAT Cardholder Activated Transaction (Visa)CAV Card Authentication Value (JCB Card)CBO Central Billing OfficeCBO Congressional Budget OfficeCBSA Core Based Statistical AreaCCAP Compliance Checker™ All Payer (Changed to ISMN)CC Complication & Co MorbidityCCD Continuity of Care DocumentCCD Corporate Credit or Debit

CCHIT Certification Commission for Healthcare Information TechnologyCCI Correct Coding InitiativeCCN Care Core National (Radiology Benefits Management Company)CCO Chief Compliance OfficerCCOW Clinical Content Objective Workgroup (One of the HL7 Standards)CCP Credit Card ProcessorCCR Continuity of Care RecordCDHP Consumer Directed Health PlanCDI Clinical Documentation ImprovementCDM Charge Description MasterCDONTS Collaboration Data Objects for Windows NT ServerCDS Clinical Decision SupportCDSS Clinical Decision Support System

CDT Current Dental TerminologyCE Covered EntityCED Coverage With Evidence DevelopmentCERT Comprehensive Error Rate TestingCFC Conditions For CoverageCFR Code of Federal Regulations (Federal Register)CFTC Commodity Futures Trading CommissionCGI Common Gateway Interface CHAMPUS Civilian Health and Medical Program, Uniformed Service (Now TriCare)CHAMPVA Civilian Health and Medical Program, Veteran Affairs (Not Same As TriCare)CHIE Clinical Health Information ExchangeCHIM Center For Healthcare Information ManagementCHIME College of Healthcare Information Management Executives

CHIN Community Health Information NetworkCHIPRA Children’s Health Insurance Program Reauthorization Act 2009CHO Comprehensive Health OrganizationCHPL Certified Health IT Product List (ONC)CHR Community Health RecordsCIA Corporate Integrity AgreementCICA Context Inspired Component Architecture (ASC X12's syntax neutral architecture)CICA Competition in Contracting Act




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CICS Customer Information Control SystemCIE Customer Initiated EntryCIFS Common Internet File SystemCIM Medicare Coverage Issues ManualCIO Chief Information OfficerCIRT Computer Incident Response TeamCIS Center For Internet SecurityCIS Clinical Information SystemCISP Cardholder Information Security Program CLFS Clinical Laboratory Fee ScheduleCLIA Clinical Laboratory Improvement AmendmentCLMA Clinical Laboratory Management AssociationCM Case ManagerCMIO Chief Medical Information OfficerCMN Certificate of Medical NecessityCMOS Complementary Metal–Oxide–SemiconductorCMP Competitive Medical PlansCMP Civil Monetary PenaltiesCMPL Civil Monetary Penalties LawCMS Centers for Medicare and Medicaid Services

CMVP Cryptographic Module Validation ProgramCNA Certified Nursing AssistantCNIO Chief Nursing Information OfficerCNO Chief Nursing OfficerCNM Certified Nurse MidwifeCNS Clinical Navigation SystemCOA Change of AddressCOA Certificate Of Authentication COB Coordination of BenefitsCOBRA The Consolidated Omnibus Budget Reconciliation Act of 1985COC Certificate of CoverageCOI Complexity of IllnessCOLA Cost of Living Allowance

COLD Computer Output to Laser DiskCORE Committee on Operating Rules For Information ExchangeCPC® Certified Professional Coder (American Academy Professional Coders)CPC-H Certified Professional Coder – HospitalCPC-P Certified Professional Coder – PayerCPG Compliance Program GuidanceCPI Consumer Price IndexCPOE Computerized Physician Order Entry (Usually IP Pharmacy Orders)CPR Computerized Patient RecordCPSI Computer Programs and Systems, IncCPT-4 Current Procedural Terminology- 4th EditionCPU Central Processing Unit CQI Continuous Quality Improvement

CR Change Request (ID Number Assigned to a CMS Transmittal)CRA Credit Reporting AgencyCRC Clinical Research CoordinatorCRCR Credentialed Revenue Cycle RepresentativeCRM Customer Relationship ManagementCRON Time-based job scheduler in Unix-like computer operating systems CROWN Consolidated Renal Operations in Web-Enabled Network CRT Cost Revenue Table (See CDM)




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CSC Card Security Code (AMEX)CSE Communications Security Establishment (Canadian Government)CSPC Claims Status Productivity CenterCSV Comma Separated ValueCTE Clinical Transaction Engine (Healthworks Acronym) CTO Chief Technology OfficerCTR Click Through Rate CT Computed Axial Tomography (see CAT)CTX Corporate Trade ExchangeCVC Card Validation Code (MasterCard)CVV Card Verification Value (Visa – Discover)CY Calendar YearDAB Department of Appeals Board (Related to Medicare Appeals)DBA Data Base AnalystDBMS Database Management SystemDCF Discounted Cash FlowDDA Demand Deposit Account DDE Direct Data EntryCDHP Consumer Directed Health PlanDEA Data Encryption Algorithm or Drug Enforcement Administration

DEFRA Deficit Reduction Act of 1984DES Data Encryption StandardDFI Depository Financial InstitutionDHCP Dynamic Host Configuration ProtocolDHHS Department of Health and Human ServicesDHTML Dynamic Hypertext Markup LanguageDICOM Digital Imaging & Communication in MedicineDISA Data Interchange Standards AssociationDLL Dynamic Link-LibraryDLP Data Loss PreventionDLPVID Data Source – Line of Business – Pathway – Version – ID NumberDME Durable Medical EquipmentDMEPOS Durable Medical Equipment – Prosthetics, Orthotics & Supplies

DMERC Durable Medical Equipment Regional Carrier (DME Claims Processing)DNE Death Notification EntryDNFB Discharged Not Final BilledDNS Domain Name System/ServerDOB Date of BirthDOEBA Date of Earliest Billing ActivityDOJ Department of JusticeDOL Department of LaborDOLBA Date of Latest Billing ActivityDPAHC Durable Power of Attorney HealthcareDPNA Denial of Payment for New AdmissionsDRA Deficit Reduction Act of 2005DRG Diagnostic Related Grouping

DRP Disaster Recovery PlanDRS Document Recognition SystemDSA Digital Signature Algorithm DSH Disproportionate Share HospitalDSL Digital Subscriber LineDSL Domain Specific LanguageDSLOB Data Source Line of BusinessDSMT Diabetes Self-Management Training




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DSS Data Security StandardDSS Decision Support SystemDSTU Draft Standard For Trial Use DTC Direct to ConsumerDTP Direct to PartnerDURSA Data Use and Reciprocal Support AgreementDWF Design Web Format Dx Shorthand for DiagnosisEAI Enterprise Application IntegrationeBXML Electronic Business XML (A suite of specifications for conducting business over the

Internet)EBITDA Earnings Before Interest, Taxes, Depreciation & AmortizationEBM Employee Benefits ManagerEBP Evidence Based PracticeEBT Electronic Benefit TransfereCare®NEXT Passport Integrated Product Suite (See Web Site)ECC Elliptic Curve CryptographyECI Employment Cost IndexECF Extended Care FacilityECOA Equal Credit Opportunity Act

EDB Environmental Data BaseEDC Enterprise Data CenterEDC Expected Date of ConfinementEDC Estimated Date of CompletionED Emergency DepartmentEDI Electronic Data InterchangeEFI Electronic File InterchangeEFS Encrypting File System EFSnet Concord/First Data Web Payment ServicesEFT Electronic Funds TransferEFX EQUIFAXEGHP Employer Group Health PlanEHNAC Electronic Healthcare Network Accreditation Commission

EHN Electronic Healthcare NetworkEHR Electronic Health RecordEIN Employer Identification NumberEIRF Electronic Interchange Reimbursement Fee (Charged by Visa/MC)ELIGIBILITY Insurance policy terms that define who is eligible to get coverage and the

requirements for receiving coverage. These may include length of employment withthe plan sponsor, job status and other provisions

E&M Evaluation and Management Coding SystemEMC Electronic Media ClaimseMEVS Electronic Medicaid Eligibility SystemEMPI Enterprise Master Patient IndexEMR Electronic Medical RecordEMS Emergency Medical Services

EMTALA Emergency Treatment & Active Labor ActENT Enteral Nutrition TherapyENTSSO Enterprise Single Sign-onEOB Explanation of BenefitsEOB Environmental Data BaseEOMB Explanation of Medical BenefitsEOP Explanation of PaymentsEPA Exclusive Provider Organization




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EPOS Electronic Point of Sale EPR Electronic Patient Record (Alternative to EMR)EPS Earnings Per ShareEPSDT Early and Periodic Screening, Diagnosis and TreatmentEQRO External Quality Review OrganizationER Emergency RoomERA Electronic Remittance Advice (835)ERC Ethics Resource CenterERISA Employee Retirement Income Security ActeRx E-PrescribingesMD Electronic Submission of Medical Documentation (CMS RAC Program)ESP Encapsulated Security Standard ESRD End Stage Renal DiseaseeTAR Electronic Treatment Authorization Request (Medi-Cal)EUI End User InvestigationEU European UnionEV Eligibility VerificationFACA Federal Advisory Committee ActFACT Fair and Accurate Credit Transactions Act of 2003FAR ` Federal Acquisition Regulation

FAST eCare® Financial Analysis Summery ToolFBA Forms Based Authentication FBI Federal Bureau of InvestigationFCA False Claims ActFCC Federal Communications CommissionFCRA Fair Credit Reporting ActFDA Food and Drug AdministrationFDC Federal District CourtFDMS First Data Merchant ServicesFECA Federal Employees Compensation ActFEC Front End CollectionsFEHP Federal Employee Health PlanFERPA Family Educational Rights & Privacy Act of 1974

FFIEC Federal Financial Institutions Examination CouncilFFP Federal Financial ParticipationFFR Federal Funds RateFFS Fee For ServiceFI Fiscal Intermediary (insurance company that administers Medicare Part A)FICO Fair Isaac and Company (Credit Scoring Model)FIFO First In First Out (Inventory Method)FIPS Federal Information Processing StandardFIS Fidelity National Information Services (Formerly Link2Gov)FISMA The Federal Information Security Act of 2003

FISS Fiscal Intermediary Standard SystemFLI Fraud Level IndicatorFOIA Freedom of Information Act

FOSS Free and Open Source/Solutions SoftwareFPL Federal Poverty LevelFQHC Federally Qualified Health CenterFRB Federal Reserve BoardFSA Flexible Spending AccountFSAP Financial Services Accreditation ProgramFSO Financial Service OrganizationFSRRA Financial Services Regulatory Relief Act of 2006




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FSS Florida Shared SystemFTC Federal Trade CommissionFTE Full Time EquivalentFTP File Transfer ProtocolFUL Federal Upper LimitFUS Follow Up SystemFx Shorthand for FractureFY Fiscal YearGAAP Generally Accepted Accounting PrinciplesGAF Geographic Adjustment FactorGAO General Accounting OfficeGAR General Audit RequirementsGCP Good Clinical PracticeGDP Gross Domestic ProductGEM General Equivalence Mapping (Typically in reference to ICD-10)GIF Graphic Interchange FormatGIPSE Geo Coded Interoperable Population Summary ExchangeGLBA The Gramm-Leach-Bliley ActGME Graduate Medical EducationGPO Group Purchasing Organization

GSA General Services AdministrationGSM Global System for Mobile CommunicationGUI Graphical User InterfaceHAC Hospital Acquired ConditionHAI Hospital Acquired InfectionHBA Health & Beauty AidsHBOT Hyperbaric Oxygen TherapyHCBS Home and Community Based ServicesHCC Hierarchical Coexisting ConditionHCCA Health Care Compliance AssociationHCFA Health Care Financing Administration (Now Known As CMS)HCFA 1450 Universal form used to bill Part A hospital based service to FI (UB-92)HCFA 1500 Universal Form for billing professional services to Part B Carrier (CMS-1500)

HCFAC Health Care Fraud and Abuse Control ProgramHCPCS Healthcare Common Procedural Coding SystemHCPP Healthcare Pre-Payment PlanHCRIS Hospital Cost Report Information SystemHDHP High Deductible Health PlanHEAT Health Care Fraud Prevention & Enforcement Action TeamHDI Health Data IntermediaryHEDIS© Health Employer Data & Information SetHETS HIPAA Eligibility Transaction SystemHFMA Healthcare Financial Management AssociationHHA Home Health AgencyHHABN Home Health ABNHHS Department of Health and Human Services

HI Hospital Insurance Trust FundHIAA Health Insurance Association of AmericaHIC Health Insurance Card or Health Insurance Claim Number (HIC number)HICN Health Insurance Card or Health Insurance Claim NumberHIDS Host based Intrusion Detection SystemHIE Health Information ExchangeHIEAP Health Information Exchange Accreditation Program (EHNAC Program)HIE-SP Health Information Exchange Service Provider




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HIH Health Information Handler (Clearing House – Claims Processor) HIM Health Information Management (Medical Records Management)HIMSS Healthcare Information Management SocietyHIN Healthcare Identification NumberHINN Hospital Issued Notice of Non-CoverageHINN II New HINN for use with diagnostics etc not bundled to Inpatient CareHIO Health Insuring OrganizationHIO Health Information OrganizationHIPAA Health Insurance Portability and Accountability Act of 1996HIPTN Health Information Partnership for TennesseeHIQA Health Insurance Query Access (DDE Eligibility)HIQH Health Insurance Query- Home (Home Health DDE Eligibility)HISB Health Informatics Standards BoardHIS Hospital Information SystemHIS Health Information ServicesHIT Health Information TechnologyHITPC Health Information Technology Policy CommitteeHITECH Healthcare Information Technology Economic & Clinical Health ActHITRC Health Information Technology Research CenterHITSC Health IT Standards Committee

HL7 Health Level 7 Interface requirements for healthcare organizationHMO Health Maintenance OrganizationHMS HealthCare Management Systems (A/R Billing Management System)HNAP Healthcare Network Accreditation Program (EHNAC Program)HOPD Hospital Outpatient DepartmentHPI History of Present IllnessHPIC Healthcare Personal Identification CardHQA Hospital Quality AssuranceHQI Hospital Quality InitiativeH.R.1 American Recover & Reinvestment Bill of 2009 (Stimulus Package)HR4157 Health Information Technology Promotion Act of 2006HRA Health Reimbursement ArrangementHRA Health Risk Assessment

HRSA Health Resources and Services AdministrationHSA Health Savings AccountHSRV Hospital Specific Relative ValueHTML Hypertext Markup LanguageHTTP Hypertext Transfer ProtocolHTTPS Hypertext Transfer Protocol SecureHx Shorthand for HistoryIAT Import Address TableIBBM Internet-Based Business ModelIBNR Incurred But Not ReportedICA Internet Check Acceptance InterfaceICD-9 International Classification Disease – 9th Edition (Diagnosis Coding System Current)ICD-10 International Classification Disease – 10th Edition (Diagnosis Coding System

Proposed)ICD-10 CM International Classification Disease – 10th Edition Clinical ModificationICD-10 PCS International Classification Disease – 10th Edition Procedure Classification SystemICE Integrated Community EHRICF Intermediate Care FacilityICH International Conference on HarmonizationICN Internal Control NumberICR Intelligent Character Recognition




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IDN Integrated Delivery NetworkIDTF Independent Diagnostic Testing FacilityIDS/IPS Intrusion Detection System/Intrusion Protection SystemID Report Demographic Portion of the EFX Credit ReportIEQ Initial Enrollment QuestionnaireIFR Interim Final RuleIFRS International Financial Reporting StandardIG Inspector GeneralIHDN Integrated Healthcare Delivery NetworkIHE Integrating Healthcare EnterpriseIHI Institute For Healthcare ImprovementIHN Integrated Healthcare NetworkIHP Indemnity Health PlanIHS Indian Health ServiceIHS Integrated Health SystemIIHI Individually Identifiable Health InformationIIS Internet Information Server – Microsoft ApplicationILM Information Lifecycle ManagementIntelliAV® Passport AV Product Abbreviation (See Website) IOM Institute of Medicine

IPA Independent Practice Association / Independent Physicians AssociationIPAM Internet Protocol Address ManagementIP InpatientIPF Inpatient Psychiatric FacilityIPIA Improper Payment Information ActIPM IntelliSource Patient ManagementIPPS Inpatient Prospective Payment System (Acute Care Hospital)IPS In Process ScriptingIRF Inpatient Rehabilitation FacilityISDN Integrated Services Digital Network ISMN IntelliSource Medical Necessity (now OrderChecker™)ISN Integrated Services NetworkISO International Standards Organization – Networks of National Standards Institute of

146 CountriesISO Independent Sales Organization (FDMS)IS Information Systems or Information ServicesIS IntelliSource (Passport Product Abbreviation)ISO 8583 Established Communication Standard Between Financial SystemsIPCARE Service provided after a patient is admitted to the hospital. Inpatient care lasts 24

hours or moreISP Internet Services ProviderIVR Interactive Voice Response or ResponderJAVA Object oriented, platform independent, programming language JCAHO Joint Commission on Accreditation of Healthcare OrganizationsJ-Code A subset of HCPCS Level II (Used to identify certain Drugs)JHITA Joint Healthcare Information Technology Alliance

JPEG Joint Photographic Experts GroupKBA Knowledgebase AssessmentKPI Key Performance IndicatorKYC Know Your CustomerL2C Passport AV PartnerLAC Latin America & Caribbean (Visa)Link2Gov Passport Legacy Credit Card Partner Gateway (Renamed FIS 1/2010) LMRP Local Medical Review Policy (Obsolete 12/2005)




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LCD Local Coverage Determination (Formerly Known As LMRP)LEIE List of Excluded Individuals and EntitiesLGHP Large Group Health PlanLIFO Last In First Out (Inventory)LINQ Language Integrated Query LIS Laboratory Information SystemLOB Line of BusinessLOI Level of InjuryLOINC® Logical Observation Identifier Names and CodesLOOP A repeating Structure or ProcessLOS Length of StayLTC Long Term CareLTCF Long Term Care FacilityMA Medicare AdvantageMAC Medicare Appeals CouncilMAC Medicare Administrative Contractor (Future replacement for Medicare FI/Carrier

System)MAC Message Authentication CodeMAP Measure Apply PerformMAPI Messaging Application Programming Interface

MCARE Medicare Customer Assistance Regarding Eligibility MCC Major Complication & Co MorbidityMCM Medical Case ManagementMCO Managed Care OrganizationMCPI Medical Consumer Price IndexMCR Medical Cost ReportMCS Medical Credit ScoreMDC Major Diagnostic CategoriesMDDS Medical Device Data SystemsMDH Medicare Dependent HospitalMDS Minimum Data SetMEDITECH Medical Information Technology, INC. (MA based Software and Service Company)MedPac Medicare Payment Advisory Commission

MEI Medicare Economic IndexMEVS Medicaid Eligibility Verification SystemMFCU Medicaid Fraud Control UnitMGMA Medical Group Management AssociationMIB Management Information BaseMID Merchant Identification NumberMIG Medicare Insured GroupMIP Medicare Integrity ProgramMIPPA The Medicare Improvements for Patients and Providers Act of 2008MITA Medicaid Information Technology AllianceMITA Medical Imaging & Technology AllianceMITS Medicaid Information Technology SystemMLN Medicare Learning Network

MLP Mid Level Practitioner (RNP PA)MLR Medical Loss RatioMLT Medical Laboratory TechnicianMMA Medicare Modernization Act of 2003MMEA Medicare & Medicaid Extender Act 2010MMIS Medicaid Management Information SystemMM Medical Management (Utilization Review Case Management)MMSEA Medicare Medicaid & SCHIP Extension Act of 2007




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MOE Maintenance of Effort (Medicaid – CHIP Rules)MPEG Moving Picture Experts Group MPI Master Patient (or Person) IndexMPN Medicare Provider NumberMPPR Multiple Procedure Payment ReductionMR Medical ReviewMRI Magnetic Resonance ImagingMSA Medicare Statistical Area or Medical Savings AccountMSA Multi-State AreaMS-DRG Medicare Severity Diagnostic Related GroupingMSP Medicare Secondary PayerM+C Medicare + ChoiceM+CO Medicare + Choice OrganizationMORCASH Medicare Outpatient Revenue Collection Assessment Service - HospitalMSA Medical Savings AccountMS-DRG Medicare Severity DRGsMSO Management Services OrganizationMSP Medicare Secondary PayerMT Medical TechnologistMTE Machine Transfer Entry

MTF Medical Treatment FacilityMUD Medically Unnecessary DaysMUD Master User DatabaseMUE Medically Unlikely EditsMx Shorthand for Metastasis NAAC Net Average Allowable Cost (EHR Technology) NACHA National Automated Clearing House Association NAHAM National Association of Healthcare Access Management NAHDO National Association of Health Data Organizations NAHIT The National Alliance For Health Information Technology NAIC National Association of Insurance Commissioners NAICS North American Industry Classification System NARB Name & Address Resource Business Database

NARC Name & Address Resource Consumer Database NARV Name & Address Resource Vehicle Database NAS Network Attached Storage NAT Network Address Translation/Transaction NBL National Business Lists NCA National Credentialing Association NCD National Coverage Determination NCH National Claims History System NCHS National Center For Health Statistics NCI National Cancer Institute NCOA National Change Of Address NCPDP National Council of Prescription Drug Programs NCQA National Committee for Quality Assurance

NCUIC National Council For Uniform Interest Compensation NCVHS National Committee on Vital and Health Statistics NDA Non Disclosure Agreement NDC National Drug Code NEC Not Elsewhere Classified NEHN New England Healthcare Exchange Network, Inc. NEIC National Electronic Information Corporation NEMB Notice of Exclusion of Medicare Benefit (Retired 3/2010)




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. NET Microsoft strategy for connecting systems, information & devices via web services NERC North American Electric Reliability Corporation NFS Network File System NHE National Health Expenditure NHIN Nationwide Health Information Network NHS National Health Service NIA National Imaging Associates (Radiology Benefits Management Company) NIC Network Interface Card NIH National Institutes of Health NIST National Institute of Standards and Technology NLR National Level Repository NMR Nuclear-Magnetic Resonance NOA Notice of Admission NOC Notice of Change NOI Notice of Intent NOPR National Oncologic PET Registry NOS Not Otherwise Specified NPI National Provider I.D. (Replaced UPIN June 2007)

NPP Non-Physician Practitioner NPRM Notice of Proposed Rule Making

NPSG National Patient Safety Goals NQF National Quality Forum NRSRO Nationally Recognized Statistical Ratings Organization NSA Non Surgical Admission NSF National Standard Format NTIS National Technical Information Service NUBC National Uniform Billing Committee NUCC National Uniform Claim Committee NVHRI National Voluntary Hospital Reporting InitiativeOAA Old Age Assistance ProgramOAS Office of Audit ServicesOASIS Outcome and Assessment Information SetOB Obstetrics

OBC Orange Book CodeOBRA Omnibus Budget Reconciliation ActOBS Observation ServicesOCE Outpatient Code EditorOCR Office of Civil RightsOCR Optical Character RecognitionODF Open Door ForumODFI Originating Depository Financial InstitutionODJFS Ohio Department of Job & Family ServicesOESS Office of E-Health Standards & Services (An Office of CMS)OGC Office of General CounselOHP Ohio Health PlanOID Object Identifier

OIG Office of the Inspector GeneralOMB Office of Management BudgetOmniLink SM McKesson centralized pharmacy softwareONC Office of the National Coordinator for Health Information TechnologyONCHIT The Office of the National Coordinator for Health Information and TechnologyOON Out of NetworkOOP Out of PlanOOP Object Oriented Programming (VB.Net)




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OP OutpatientOPCARE Care provided in a clinic, emergency room, hospital or non-hospital surgical center,

without admitting the patient.OPD Outpatient DepartmentOPPS Outpatient Prospective Payment SystemOrderRite™ PHC Product Manages Pre-Certs, Medical Necessity (See Web Site)ORMIS Operating Room Management Information SystemOSI Open System InterconnectionOS OneSource (Passport Product Abbreviation)OT Occupational TherapyOTS Office of Thrift SupervisionP4P Pay For PerformancePACS Picture Archiving Communications System (Radiology EHR)PACT Post Acute Care Transfer RulePAH Patient Account HistoryPAHP Pre-Paid Ambulatory Health PlanPAN Primary Account NumberPAPB Payer Application Best PracticePAPD Planning Advice Planning DocumentPAT Pre-Admission Testing

PAV Patient Access VerificationPayment Navigator PHC Product Financial Screening (See Web Site)P/BAR Patient/Billing Accounts Receivable SystemPBM Pharmacy Benefits ManagerPCA™ Pre-Submission Compliance AnalyzerPC Professional Component (Billing Term)PCI Pending Client Issues (PHC Enrollment Term)PCI Payment Card IndustryPCI DSS Payment Card Industry Data Security StandardPCIP Pre-Existing Condition Insurance PlanPCI SSC Payment Card Industry Security Standards CouncilPCOA Proprietary Change of AddressPCP Primary Care Physician

PCPM Per Contract Per MonthPDE Prescription Drug EventPDP Prescription Drug PlanPEPPER Program For Evaluating Payment Patterns Electronic ReportPET Positive Emission TomographyPERM Payment Error Rate MeasurementPFI PCI Forensic InvestigatorPFOS Patient Financial Obligation StatementPFS Physician Fee SchedulePHB Pharmacy Benefits ManagerPHC Passport Health Communications, Inc.PHCP Primary Healthcare Physician or ProviderPHI Protected Health Information

PHO Physician Hospital OrganizationPHR Personal Health RecordPHS Public Health ServicePHSA Public Health Service ActPIC Passport IntelliSource ClientPIMS Pharmacy Information Management SystemPIN Personal Identification NumberPIPEDA Personal Information Protection and Electronic Documents Act




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PKI Public Key InfrastructurePL Patient LocatorPM Program MemorandumPMH Patient Medical HistoryPMPM Per Member Per MonthPM/R Physical Medicine/Rehabilitation (PT – OT & Speech Therapy)PMS Practice Management System (Physicians Office Environment)PNG Portable Network GraphicsPOA Present on Admission POC Plan of Care or Point of Care – Proof of CoveragePOF Proof Of FundsPOP Point of PurchasePPA Preferred Provider ArrangementPPACA Patient Protection and Affordable Care ActPPC Provider-Preventable ConditionPPCE Provider Payment Cost EstimationPPD Prearranged Payment & DepositPPE PHC Product - Patient Payment Estimator (See Web Site)PPI Provider Price IndexPPS Prospective Payment System

PPO Preferred Provider OrganizationPPR Paper Based Patient RecordPPS Prospective Payment SystemPQRI Physician Quality Reporting InitiativePRA Paperwork Reduction ActPRE-CERT The process of receiving approval for some health care, such as hospitalization,

outpatient surgery or prescription drugs, before it can be covered.PRG Procedure Related GroupPRM Provider Reimbursement ManualPRO Peer Review OrganizationPRS Practice Related Risk ScorePOC Point of CarePOS Point (or Place) of Service or Point of Sale

PSH Patient Surgical HistoryPSN Provider Sponsored NetworksPSO Provider Service OrganizationPTAN Provider Transaction Access NumberPTD Payer Transaction DensityPTO Paid Time OffPT Physical TherapyPVV PIN Verification ValuePWK Paperwork Segment X12N Version 5010Px Shorthand for ProcedureQHR Quorum Health ResourcesQIC Qualified Independent Contractor (Related to Medicare Appeals)QIO Quality Improvement Organization

QOS Quality of ServiceQRDA Quality Reporting Document ArchitectureQSA Qualified Security AssessorRA Remittance Advice (ERA – 835)RAC Recovery Audit ContractorRAID Redundant Array of Independent Disks RAND Research and Development CorporationRARC Remittance Advice Remark Code




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RBM Radiology Benefits ManagerRBRVS Resource-Based Relative Value ScaleRCK Re-Presented CheckRCM Revenue Cycle ManagementRCS Revenue Cycle SolutionsRDFI Receiving Depository Financial InstitutionRDP Remote Desktop Protocol – Terminal ServicesRDRG Refined Diagnostic Related GroupingREC Regional Extension Center (Health Information Technology)REFERRAL Specific directions or instructions from a member's PCP that directs a member to a

participating health care professional for medically necessary care. A referral may bewritten or electronic

RHC Rural Health ClinicRHIO Regional Health Information OrganizationRHIT Registered Health Information TechnicianRIA Regulatory Impact AnalysisRIAA Recording Industry Association of AmericaRLS Record Locator ServiceRRAS Request and Response Aggregation SupportRN Registered Nurse

ROA Return on AssetsROC Report on ComplianceROE Return on EquityROI Return on InvestmentRPO Recovery Point ObjectiveRQA PHC Product - Registration Quality Assurance (See Web Site)RRA Registered Records AdministratorRRT Registered Respiratory TherapistRTE Response Transaction EmbellishmentRTO Recovery Time ObjectiveRUG Resource Utilization GroupsRULE Review Utilization Line Edit (Medicare Processing)RVS Relative Value Scale

RVU Relative Value UnitRx Shorthand for PrescriptionRY Rate YearSA Search AmericaSAAS Software As A Service (SaaS)SAF Standard Analytical FileSAN Storage Area NetworkSAQ Self Assessment QuestionnaireSAS70 Statement on Auditing Standard 70SB Separately BillableSBA Small Business AdministrationSCH Sole Community HospitalSCHIP State Children’s Health Insurance Program (Reference Medicaid)

SCSI Small Computer System InterfaceSDC Surgical Day CareSDEs State Designated EntitiesSDO Small Dialysis OrganizationSEC Securities & Exchange CommissionSEC Standard Entry Class CodesSEO Search Engine optimizationSFR Sliding Fee Review




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SFY State Fiscal YearSGR Sustainable Growth RateSHA Secure Hash AlgorithmSIC Standard Industrial ClassificationSIEM Security Incident and Event ManagementSLA Service Level AgreementSMHP State Medicaid Health Information Technology PlanSMI Supplementary Medical InsuranceSMP Senior Medicare PatrolSMS Shared Medical SystemsSNF Skilled Nursing FacilitySNIP Strategic National Implementation Process (A WEDI program)SNMP Simple Network Management ProtocolSNOMED Systematized Nomenclature of MedicineSOAP Subjective Objective Assessment & Plan (Charting System)SOAP Simple Object Access ProtocolSOC Standard Occupational ClassificationsSOM State Operations ManualSOW Statement of WorkSOX Abbreviation for Sarbanes-Oxley

SP Self PaySPSP Society of Payment Security ProfessionalsSPD Summary Plan DescriptionSPML Service Provisioning Markup LanguageSPR Self Pay ReviewSRE Serious Reportable EventSSA Social Security AdministrationSSA DMF Social Security Administration Death Master FileSSEL Standard Statistical Establishment ListSSI Supplemental Security IncomeSSID Service Set IdentifierSSIS SQL Server Integration ServicesSSMS SQL Server Management Studio

SSN Social Security NumberSSO Standard Setting OrganizationSSO Single Sign-onSSRS SQL Server Reporting ServicesS&S Store & ServeSTC Service Type CodeSQL Structured Query Language - Software language used to talk to most databasesSUNQUEST Laboratory Information System Brand NameSURS Surveillance & Utilization Review Subsets UnitsSWG Sub Work GroupSx Shorthand for symptomsTA1 Interchange AcknowledgementTAG Technical Advisory Group (CMS Department)

TARP Troubled Assets Relief ProgramTC Technical Component (Billing Term)TCM Targeted Case ManagementTCP/IP Transmission Control Protocol/Internet ProtocolTDES Triple Data Encryption Standard (AKA 3DES)TFL TriCare For LifeTID Terminal Identification NumberTIN Taxpayer Identification Number




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TLS Transport Layer SecurityTNF True Name FraudTNR Telephone Number ResourceTOA Threshold Override AuthorizationTPA Third Party Administrator (Healthcare Claims Processing Entity)TPL Third Party LiabilityTPMS Trading Partner Management SystemTPO Treatment Payment & Healthcare OperationsTPP Transaction Processing PlatformTPR Transaction Protocol RedirectionTPSP Third Party Service ProviderTPTS Trading Partner Tracking SystemTQM Total Quality ManagementTRHCA Tax Relief Healthcare Act of 2006TRN Transaction AcknowledgementT-SQL Transact- SQL is central to using SQL ServerTTM Time To MarketTx Shorthand for TreatmentUAA Undeliverable as AddressedUAT User Acceptance Testing

UB Uniform BillUB-92 Universal Billing Form used to bill Part A hospital based service to FI (HCFA 1450)UB-04 Universal Billing Form (paper) (replaced UB-92 March 2007)UCAT Unattended Cardholder Activated Transaction (Visa)UCC Uniform Commercial CodeUCF Uniform Claim FormUCR Usual Customary and Reasonable feesUCRN Unique Claim Record NumberUCUM Unified Code For Unites of MeasureUDRVs User Definable Response ViewsUETA Uniform Electronic Transactions ActUHDDS Uniform Hospital Discharge Data SetUHIN Utah Health Information Network

UI User InterfaceUM Utilization Management (AKA Medical Management)UNII Unique Integrated IdentifierUOE Universal Order EntryUOS Units of ServiceUPC Universal Product CodeUPD Universal Provider DatasourceUPIN Unique Physician Identification Number (Discontinued by CMS June 29,2007)UPL Upper payment limitURO Utilization Review OrganizationUROE Universal Remote Order EntryUR Utilization Review (Case Management / Medical Management)URL Uniform Resource Locator

USAO United States Attorney’s OfficeUSB Universal Serial BusUSC United States CodeUSHEI The United States Healthcare Efficiency Index© USPS United States Postal ServiceUSRDS United States Renal Data SystemVA Veterans AdministrationVAN Value Added Network




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VAR Value Added ResellerVB.NET Visual Basic.NET Object-oriented programmingVBP Value Based PurchasingVEBA Volunteer Employee Benefits AssociationVFCRA Vermont Fair Credit Reporting ActVHA Veterans Hospital AdministrationVHA Volunteer Hospital AssociationVIPS Viable Information Processing SystemVMAP ViPS Medicare Automated ParameterVOL Visa On-LineVPN Virtual Private NetworkVPS Volume Performance Standard SystemWAC Wholesale Acquisition CostWAMP Widely Available Market PriceWEDI Workshop for Electronic Data InterchangeWEP Wired Equivalent PrivacyWFM Workflow ManagementWG WorkgroupWHO World Health OrganizationWIC Women’s Infants & Children (Special Supplemental Nutrition Program)

WIR Week In ReviewWPC Washington Publishing CompanyWPI WiFi Protected AccessXACTION TransactionXML Extensible Markup Language-Standards for HL7’s entire platformXSL XML Style sheet LanguageX12 An ANSI-accredited group that defines EDI standards for many American industries,

including healthcare insuranceX12 270 The X12 HealthCare Eligibility & Benefit Inquiry transactionX12 271 The X12 Health Care Eligibility & Benefit Response transactionX12 276 X12 Healthcare Claims Status InquiryX12 277 X12 Claims Status ResponseX12 277CA Claim Acknowledgement Transaction

X12 278 Referral, pre-certification or authorization inquiry or submitX12 834 X12 Enrollment & Maintenance TransactionX12 835 X12Healthcare Claim Payment and Remittance Advice TransactionX12 837 X12 Healthcare Claim or Encounter TransactionX12 837i See X12 837 Institutional VersionX12 837p See X12 837 Professional VersionX12 997 Functional Acknowledgement for 837 ClaimsX12 999 Acknowledgement transaction using Technical Report type 3X12 TA1 Technical AcknowledgmentXSS Cross Site ScriptingYPDA Yellow Pages Directory AssistanceYPDD Yellow Pages Data DeliveryYTD Year To Date

ZCTA Zip Code Tabulation AreaZPP Medicare HMO Zero Premium Plans

Glossary September 2011

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Transcript of Glossary September 2011