Abbreviations and Acronyms
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
BB -
Balance
billing
C
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
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
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
FFS - Fee For Service Equivalency
FFS - Fee For Service Reimbursement
FSA - Flexible Spending Account
G
GHAA - Group Health Association of
America, see AAHP
H
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
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
JCAHO - Joint Commission on
Accreditation of Health Care Organizations
L
LCP - Licensed Clinical Psychologist
LCSW - Licensed Clinical Social
Worker
LOS - Length Of Stay
LPC - Licensed Professional Counselor
M
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
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
OA - Open Access
OOA - Out-Of-Area
OOPs - Out-Of-Pocket costs/expenses
OSHA - Occupational Safety and Health
Administration
OTC - Over-The-Counter
P
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
QA - Quality Assurance
QM - Quality Management
QMB - Qualified Medicare Beneficiary
R
R&C - Reasonable and Customary
RBRVS - Resource Based Relative Value
Scale
Retro - Retrospective Rate Derivation
RFP - Request For Proposal
RMC - Rating Method Code
S
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
TAT - Turnaround Time
TEFRA - Tax Equity and Fiscal
Responsibility Act
TPA - Third Party Administrator
TRICARE -
Military healthcare
U
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
V
VE - Voluntary Effort
W
WEDI - Workgroup for Electronic Data
Interchange
YTD - Year-To-Date
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04.25.2010
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