Abbreviations and Acronyms




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A     To the top

AAHP - American Association of Health Plans

AAPCC - Adjusted Average Per Capita Cost

AAPPO - American Association of Preferred Provider Organizations

ACR - Adjusted Community Rating

ACSW - Academy of Certified Social Workers

ADA - Americans with Disabilities Act

ADM - Alcohol, Drug or Mental Disorder

ADS - Alternative Delivery System

AHA - American Hospital Association

AHC - Alternative Health Care

AHIP - Americas Health Insurance Plans

AHP - Accountable Health Plan

ALOS - Average Length Of Stay

AMA - American Medical Association

AMCRA - American Managed Care and Review Association, see AAHP

APT - Admissions Per Thousand

ASO - Administrative Services Only

ASR - Age/Sex Rate

AUR - Ambulatory Utilization Review

AWP - Average Wholesale Price


 B    To the top

BB - Balance billing


C    To the top

CAC - Certified Alcoholism Counselor

Cap - Capitation

CHAMPUS - Civilian Health and Medical Program of the Uniformed Services  Now Tricare

CMP - Competitive Medical Plan

CMS - Centers for Medicare and Medicaid Services

COA - Certificate Of Authority

COB - Coordination Of Benefits

COBRA - Consolidated Omnibus Budget Reconciliation Act

COC - Certificate Of Coverage

CON - Certificate Of Need

CPHA - Commission on Professional and Hospital Activities

CPT - Physician's Current Procedural Terminology

CQI - Continuous Quality Improvement

CR - Carrier Replacement

CRC - Community Rating By Class


D    To the top

DAW - Dispense As Written

DC - Defined Contribution Plan

DCA - Deferred Compensation Administrator

DCI - Duplicate Coverage Inquiry

DME - Durable Medical Equipment

DO - Doctor Of Osteopathy

DOB - Date Of Birth

DOH - Department Of Health

DOS - Date Of Service

DPR - Drug Price Review

DPT - Days Per Thousand

DRG - Diagnosis Related Group

DSMIII-R - Diagnostic And Statistical Manual, 3rd Edition, Revised

DUE - Drug Use Evaluation

DUR - Drug Utilization Review

DX - Diagnosis Code


E    To the top

EAP - Employee Assistance Program

EDI - Electronic Data Interchange

EOB - Explanation Of Benefits

EOI - Evidence Of Insurability

EOM - End Of Month

EOMB - Explanation Of Medicare Benefits

EOY - End Of Year

EPO - Exclusive Provider Organization

ERISA - Employee Retirement Income Security Act of 1974


F    To the top

FFS - Fee For Service Equivalency

FFS - Fee For Service Reimbursement

FSA - Flexible Spending Account


G    To the top

GHAA - Group Health Association of America, see AAHP



H    To the top

HCFA - Health Care Financing Administration

HCFA 1500 - a universal billing form developed by HCFA

HCPCS - HCFA Common Procedural Coding System

HCPP - Health Care Prepayment Plan

HEDIS - Health Plan Employer Data and Information Set

HHA - Home Health Agency

HHS - Department of Health and Human Services

HIAA - Health Insurance Association of America

HIPAA - Health Insurance Portability and Accountability Act of 1996

HIPC - Health Insurance Purchasing Cooperative

HMO - Health Maintenance Organization

HPO - Hospital Physician Organization

HRA - Health Reimbursement Account

HSA - Health Savings Account

HSA - Health Service Agreement

HSP - Health Service Plan


I    To the top

IBNR - Incurred But Not Reported

ICD - see ICD-9-CM

ICD-9-CM - International Classification of Diseases, 9th Edition (Clinical Modification)

ICF - Intermediate Care Facility

IMO - Integrated Multiple Option

IPA - Individual Practice Association

IME - Independent Medical Evaluation

ISN - Integrated Service Network


J    To the top

JCAHO - Joint Commission on Accreditation of Health Care Organizations


To the top

LCP - Licensed Clinical Psychologist

LCSW - Licensed Clinical Social Worker

LOS - Length Of Stay

LPC - Licensed Professional Counselor


M    To the top

MAC - Maximum Allowable Cost

MCR - Modified Community Rating

MD - Medical Doctor

MDC - Major Diagnostic Category

Medigap - Medicare Supplement Insurance

Medsupp - Medicare Supplement Insurance

MH/CD - Mental Health/Chemical Dependency

MH/SA - Mental Health/Substance Abuse

MRI - Magnetic Resonance Imaging

MSA - Medical Savings Account

MSHJ - Medical Staff Hospital Joint Venture

MSO - Management Service Organization

MSS - Medical Social Services

MSW - Master's in Social Work



N    To the top

NAEHCA - National Association of Employers on Health Care Action

NAHMOR - National Association of HMO Regulators

NAIC - National Association of Insurance Commissioners

NCPDP - National Council of Prescription Drug Programs

NCQA - National Committee on Quality Assurance

NDC - National Drug Code

Non-par - Non-participating Provider

NPA - National Prescription Audit

NPA - Non-par Approved

NPN - Non-par Not Approved



O    To the top

OA - Open Access

OOA - Out-Of-Area

OOPs - Out-Of-Pocket costs/expenses

OSHA - Occupational Safety and Health Administration

OTC - Over-The-Counter



P    To the top

P&T - Pharmacy and Therapeutics

PAC - Pre-Admission Certification

Par - Participating Provider

PCN - Primary Care Network

PCP - Primary Care Physician

PCPM - Per Contract Per Month

PCR - Physician Contingency Reserve

PEC - Pre-Existing Condition

PharmD - Doctor of Pharmacy

PHO - Physician-Hospital Organization

PMG - Primary Medical Group

PMPM - Per Member Per Month

PMPY - Per Member Per Year

POP - Premium Only Plan

POS - Point Of Service (or Point Of Sale)

PPO - Preferred Provider Organization

PPRC - Physician Payment Review Commission

PRO - Professional (or Peer) Review Organization

ProPAC - Prospective Payment Assessment Commission

PsyD, LCP - Doctor of Psychology, Licensed Clinical Psychologist


Q    To the top

QA - Quality Assurance

QM - Quality Management

QMB - Qualified Medicare Beneficiary



R    To the top

R&C - Reasonable and Customary

RBRVS - Resource Based Relative Value Scale

Retro - Retrospective Rate Derivation

RFP - Request For Proposal

RMC - Rating Method Code


S    To the top

SCR - Standard Class Rate

SIC - Standard Industry Code

SMI - Supplementary Medical Insurance Program

SNF - Skilled Nursing Facility

SPD - Summary Plan Description

SPIN - Standard Prescriber Identification Number

SVC - Service



T    To the top

TAT - Turnaround Time

TEFRA - Tax Equity and Fiscal Responsibility Act

TPA - Third Party Administrator

TRICARE - Military healthcare


U    To the top

U&C - Usual and Customary

UB-92 - Uniform Billing Code of 1992

UCR - Usual, Customary and Reasonable

UM - Utilization Management

UPIN - Universal Physician Identification Number

UR - Utilization Review

URAC - Utilization Review Accreditation Commission

UR/QA - Utilization Review/Quality Assurance



VE - Voluntary Effort



WEDI - Workgroup for Electronic Data Interchange

YTD - Year-To-Date

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