Abbreviations

WHO – World Health Organization

IPAs - Individual Practice Associations

HMOs - Health Maintenance Organizations

HIPAA - Health Insurance Portability and Accountability Act

ACA - Affordable Care Act

ROI – Release of Information

AOB - Assignment of Benefits

CMS – Centers for Medicare and Medicaid Services

UB - Uniform Billing

NSF – National standard format

ANSI – American National Standard institute

EOB – Explanation of Benefits

ICN/TCN – Internal / Transaction Control #

EFT - Electronic Fund Transfer

EDI - Electronic data Interchange

OCR – Optical character recognition

NPI - national provider identifier

PCP –Primary Care Physician

SIU - special investigative unit

ICD-9- CM - International Classification of Diseases, Ninth Revision, Clinical Modification

HCPCS - Healthcare Common Procedural Coding System

CPT - Current Procedural Terminology

UPIN - Unique Physician Identification Number

PIN -Provider Identification Number

TIN - Taxpayer Identification Number

SSN – Social Security number

ITIN - Individual Taxpayer Identification Number

EIN - Employer Identification Number

FEIN - Federal Employer Identification Number

ABN – Advance Beneficiary Notice

TFL - Timely Filing Limit

PTFL - Proof of timely filing Limit

OWCP - OFFICE OF WORKER’S COMPENSATION PROGRAM

WCB - Worker’s Compensation Board

TWCC - Texas Worker’s Compensation Council

DIA - DEPARTMENT OF INSPECTIONS AND APPEALS

FEHP - Federal Employees Health Benefits

NAIC - National Association of Insurance Commissioners

CVOs - credentialing verification organizations

IPA - Independent Practice Association

GPWW - Group Practice Without Walls

MSO - Management Services Organization

PHCO - Physician hospital community organization

IDS - Integrated Delivery System

ACO - Accountable Care Organization

PCMH - Patient-Centered Medical Home

FFS – Fee For Service

PMPM - Per Member Per Month

DRGs - Diagnosis-Related Groups

P4P - Pay for Performance Programs

EGHP - Employer Group Health Plan

LGHP - Large Group (Employer) Health Plan

SGHP - Small Group (Employer) Health Plan

NCQA - National Committee for Quality Assurance

PCPs – Primary Care Providers

RBRVS - Resource-Based Relative Value Scale

PPO - Preferred Provider Organization

TPA - Third-party administrator

EPOs - Exclusive Provider Organizations

POS - Point-of-Service

DHMOs - dental health maintenance organizations

MBHO - managed behavioral health organization

LCSWs - licensed clinical social workers

MFCCs - marriage, family, and child counselors

MHPA - Mental Health Parity Act of 1996

MHPAEA - Mental Health Parity and Addiction Equity Act of 2008

PBM - Pharmacy Benefit Management Plan

DUR - Drug utilization review

CDHPs - Consumer-directed health plans

HDHP - high-deductible health plan

FSAs - Flexible Spending Accounts

MSAs - Medical Savings Accounts

HSAs - health savings accounts

HRAs - Health Reimbursement Arrangements

SNF – Skilled Nursing Facility

RRB - Railroad Retirement Board

FICA - Federal Insurance contributions Act

ESRD – End Stage Renal Disease

ALS – Amyotrophic Lateral sclerosis

PFFS - private fee-for-service

PDPs - prescription drug plans

TEFRA - Tax Equity and Fiscal Responsibility Act of 1982

BBA - Balanced Budget Act of 1997

MMA - Medicare Modernization Act

PSOs - provider-sponsored organizations

MA - Medicare Advantage

CCPs - Coordinated care plans

MMSA - Medicare medical savings account

SNPs - Special needs plans

CHIP - Children’s Health Insurance Program

FEHB - Federal Employees Health Benefits

FPL - federal poverty level

SSI - Supplemental Security Income

PCCM - primary care case management

HIO -health insuring organization

PIHP - prepaid inpatient health plan

PAHP - prepaid ambulatory health plan

MCO – Managed Care Organization

OPM - Office of Personnel Management

CHAMPVA - Civilian Health and Medical Program of the Department of Veterans Affairs

NOAA - National Oceanic and Atmospheric Administration

MTF - Military treatment facility

CEO - chief executive officer

CFO - chief financial officer

COO - chief operations officer

CMO - chief marketing officer

CIO - chief information officer

CMO - chief medical officer

HIPAA - Health Insurance Portability and Accountability Act of 1996

HRA - Health Risk Assessment

PHRs - Personal health records

URO - utilization review organization

DM - Disease management

QM – Quality Management

FDA - Food and Drug Administration

NCQA – National Committee of Quality Assurance

CTI - computer/telephony integration

ACDs - automatic call distributors

IVR - interactive voice response

CRPs - complaint resolution procedures

IRO - independent review organization

OPM - Office of Personnel Management

EDI - Electronic data interchange

PHR - personal health record

EHR - electronic health record

PHI - protected health information

NPP - Notice of Privacy Practice

ERISA - Employee Retirement Income Security Act

GLB - Gramm-Leach-Bliley Act

COBRA - Consolidated Omnibus Budget Reconciliation Act of 1986

COA - certificate of authority

UR - utilization review

SHOP - Small Business Health Options Program

HHA – Home Health Agencies

DME – Durable Medical Equipment

GHI – Group Health Insurance

OCR – Optical Character Recognition

AMA – American Medical Association

NCM – National Coding Manual

NPDB – National Physician Data Bank

IRS – Internal Revenue Service

UMR – Utilization Management Review

IME – Independent Medical Examination

SSA – Social Security Administration

UCR – Usually Customary Rate

BOA – Basket of Allowance