HIPAA Glossary ABC

Accredited Standards Committee (ASC): An organization that has been accredited by ANSI for the development of American National Standards. ADA: The American Dental Association.

Administrative Code Sets: Code sets that characterize a general business situation, rather than a medical condition or service.

Administrative Simplification (A/S): Title II, Subtitle F, of HIPAA, which gives DHHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information.

AFEHCT: The Association for Electronic Health Care Transactions.

AHA: The American Hospital Association.

AHIMA: The American Health Information Management Association.

AMA: The American Medical Association.

American Dental Association (ADA): A professional organization for dentists. The ADA maintains the hardcopy dental claim form and the associated claim submission specifications, and also maintains the Current Dental Terminology (CDTä ) code set. The ADA has a formal consultative role under HIPAA, and hosts the Dental Content Committee. American Health Information Management

Association (AHIMA): An association of health information management professionals. AHIMA sponsors some HIPAA educational seminars.

American Medical Association (AMA): A professional organization for physicians. The AMA is the secretariat of the NUCC, which has a formal consultative role under HIPAA. The AMA also maintains the Current Procedural Terminology (CPTä ) code set. American Hospital Association (AHA): A health care industry association that represents the concerns of institutional providers. The AHA hosts the NUBC, which has a formal consultative role under HIPAA.

American National Standards (ANS): Standards developed and approved by organizations accredited by ANSI.

American National Standards Institute (ANSI): An organization that accredits various standards-setting committees, and monitors their compliance with the open rule-making process that they must follow to qualify for ANSI accreditation.

American Society for Testing and Materials (ASTM): A standards group that has published general guidelines for the development of standards, including those for health care identifiers. ASTM Committee E31 on Healthcare Informatics develops standards on information used within healthcare.

ANS: American National Standards.

ANSI: The American National Standards Institute.

A/S: Administrative Simplification, as in HIPAA A/S.

ASC: Accredited Standards Committee, as in ANSI ASC X12.

Association for Electronic Health Care Transactions (AFEHCT): An organization that promotes the use of EDI in the health care industry.

ASTM: The American Society for Testing and Materials.

BCBSA: The Blue Cross and Blue Shield Association.

Biometric Identifier: An identifier based on some physical characteristic, such as a fingerprint.

Blue Cross and Blue Shield Association (BCBSA): An association that represents the common interests of Blue Cross and Blue Shield health plans. The BCBSA serves as the administrator for both the Health Care Code Maintenance Committee and the Health Care Provider Taxonomy Committee.

Business Model: A model of a business organization or process.

CDC: The Centers for Disease Control and Prevention.

CDTä : Current Dental Terminology. Centers for Disease Control and Prevention (CDC): An organization that maintains several code sets included in the HIPAA standards, including the ICD-9-CM codes.

Claim Adjustment Reason Codes: A national code set for indicating the reasons for any differences, or adjustments, between the original provider charge for a claim or service and the current payment for it. This code set is used in the X12 835 Claim Payment & Remittance Advice and the X12 837 Claim EDI transactions, and is maintained by the Health Care Code Maintenance Committee.

Claim Attachment: Any of a variety of hardcopy forms or electronic records needed to process a claim in addition to the claim itself.

Claim Medicare Remarks Codes: See Medicare Remittance Advice Remark Codes.

Claim Status Codes: A national code set for indicating the status of health care claims. This code set is used in the X12 277 Claim Status Notification EDI transaction, and is maintained by the Health Care Code Maintenance Committee.

Claim Status Category Codes: A national code set for indicating the general category of the status of health care claims. This code set is used in the X12 277 Claim Status Notification EDI transaction, and is maintained by the Health Care Code Maintenance Committee.

Clearinghouse (or Health Care Clearinghouse): For health care, an organization that translates health care data to or from a standard format.

CM: See ICD.

COB: Coordination of Benefits, or crossover.

Comment: Commentary on the merits or appropriateness of proposed or potential regulations provided in response to an NOI, an NPRM, or other federal regulatory notice.

Computer-based Patient Record Institute (CPRI): An industry organization that promotes the use of electronic healthcare records.

Coordination of Benefits (COB): A process for determining the respective responsibilities of two or more health plans that have some financial responsibility for a medical claim. Also called crossover.

CPRI: Computer-based Patient Record Institute.

CPTä : Current Procedural Terminology. Current Dental Terminology (CDTä ): A dental procedure code set maintained by the ADA, and that has been selected for use in the HIPAA transactions. Current Procedural Terminology (CPTä ): A procedure code set maintained and copyrighted by theAMA, and that has been selected for use under HIPAA for non-institutional and non-dental professional transactions.