Definitions and Glossary Terms
- ANSI
- Standard X12 healthcare claim file transactions.
- Channel Partners
- IT companies who partner to provide an end to end solution that help automate the exchange of information between providers, health plans, clearinghouses, and other heathcare entities.
- Clearinghouse
- An entity that standardizes health information.
- CORE
- Committee on Operating Rules for Information Exchange.
- Direct-Connectivity
- Electronic transaction trading direct to the payer without going through a clearinghouse.
- Doohickey
- Doohickey reporting system for payers, which includes complete transaction status reports.
- HCFA
- Health Care Financing Administration.
- HEDIS
- Health Plan Employer Data & Information Set Managed care An initiative by the National Committee on Quality Assurance to develop, collect, standardize, and report measures of health plan performances.
- HIPAA
- The Health Insurance Portability and Accountability Act (HIPAA) of 1996.
- HL7
- (Health Level 7) ANSI-accredited standards for electronically defining clinical and administrative data in the healthcare industry. HL7 is one of several Standards Developing Organizations in healthcare. The "7" comes from application layer 7 in the OSI model, which is the highest level where programs talk to each other.
| - ICD-10
- The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO).
- NCPDP
- National Council for Prescription Drug Programs.
- NSF
- National Standard Format - A proprietary, 320-byte flat file record format used to submit professional claims. Not a HIPAA standard.
- Platform
- Hardware architecture and software framework.
- Point-to-Point
- Direct to payer.
- Proprietary
- Print image or National Standard Format.
- Real-time
- HIPAA-standard ASC X12N format, supporting eligibility inquiry and response (270/271), claims status (276/277).
- SNIP7
- Implementation Guide-Specific Trading Partners.
- Trading Partner
- Healthcare Electronic Data Interchange Trading Partner.
- UB-04
- The standard, uniform bill (UB) for institutional healthcare providers that’s used throughout the U.S. is known as the UB-04, which replaced the UB-92 following a four-year study involving National Uniform Billing Committee (NUBC) members and various public surveys. The UB form is used by hospitals, nursing homes, hospice, home health agencies, and other institutional providers.
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