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AACR |
American Association for Cancer Research |
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AAHA |
American Association of Homes for the Aging |
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AAHP |
American Association of Health Plans |
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AAHSA |
American Association of Homes and Services for the Aging |
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AAKP |
American Association of Kidney Patients |
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AARP |
American Association of Retired Persons |
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ABD |
Aged, Blind & Disabled |
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|
ABH |
Association of Behavioral Healthcare |
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|
ABR |
American Board of Radiology |
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|
ABS |
Annual Beneficiary Summary |
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AC |
Actual Charge |
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ACA |
Amputee Coalition of America |
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|
ACF |
Administration for Children and Families |
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ACR |
Adjusted Community Rate |
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|
ACRP |
Adjusted Community Rate Proposal |
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|
ACS |
American Cancer Society |
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|
ACSI |
American Customer Satisfaction Index |
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|
ACTG |
AIDS Clinical Trials Group |
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ACYF |
Administration on Children, Youth, and Families |
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|
ADA |
Americans With Disabilities Act Of 1990 (Text Of ADA Legislation) |
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ADAP |
AIDS Drug Assistance Program |
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|
ADC |
Adult Day Care |
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|
ADL |
activity of daily living |
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ADMS |
Alcohol, Drug Abuse and Mental Health Services |
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|
ADP |
Alternative Disposition Plan |
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|
ADP |
Advance Planning Document |
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|
ADT |
Admission/Discharge Transfer |
|
|
AEP |
Annual Coordinated Election Period |
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|
AFDC |
Aid to Families with Dependant Children |
|
|
AHA |
American Hospital Association |
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|
AHA |
American Heart Association |
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|
AIC |
Amount in Controversy |
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AKF |
American Kidney Fund |
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|
ALOS |
Average Length Of Stay |
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ALS |
Advanced Life Support |
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|
ALT |
Average Length of Treatment |
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|
AMA |
American Medical Association |
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|
AMCP |
Academy of Managed Care Pharmacy |
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|
ANA |
Administration for Native Americans |
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|
ANCI |
American National Standards Institute |
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|
AO |
Accreditation Organization |
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|
AoA |
Administration on Aging |
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|
APD |
Advanced Planning Documents |
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|
APTD |
Aid to the Permanently & Totally Disabled |
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|
AQL |
Acceptable Quality Level |
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ARC |
American Red Cross |
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|
ASAP |
American Society of Automation in Pharmacy |
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ASHP |
American Society of Health Systems Pharmacists |
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|
AWP |
Average Wholesale Price |
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|
BAC |
Beneficiary Advisory Committee |
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|
BBA |
Balanced Budget Act |
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|
BBRA |
Balanced Budget Refinement Act of 1999 (PL 106113) |
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|
BC/BS |
Blue Cross/Blue Shield |
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|
BCB |
Beneficiary Confidentiality Board |
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|
BCBSA |
Blue Cross/Blue Shield Association |
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|
BCF |
Benefit Correction Form |
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|
BLS |
Bureau of Labor Statistics of the United States Department of Labor |
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|
BP |
Benefit Period |
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|
CAH |
Critical Access Hospital |
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|
CAHP |
Consumer Assessment of Health Plan |
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CAHPS |
Consumer Assessments of Health Plans Survey |
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CalPERS |
California Public Employees' Retirement System |
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casper |
Certification and Survey Provider Enhanced Reporting |
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CBI |
Confidential Business Information |
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|
CCIP |
Chronic Care Improvement Programs |
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CCP |
Comprehensive Compliance Program |
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ccrc |
Continuing Care Retirement Community's |
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CDC |
Center for Disease Control and Prevention |
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CHIP |
Child Health Insurance Program |
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|
CHOW |
Change of Ownership |
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CLT |
Certified Lab Technician |
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CMP |
Competitive Medical Plan |
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CMS |
Correctional Medical Services |
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CN |
Claim Number |
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COA |
Change of Address |
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|
COB |
Coordination of benefits |
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|
COBA |
Coordination of Benefits Agreement |
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|
COBC |
Coordination of Benefits Contractor |
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|
COBRA |
Consolidated Omnibus Budget Reconciliation Act of 1985 |
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CPAP |
Continuous Positive Airway Pressure |
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|
CPD |
Competitive Pricing Demonstration |
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|
CPI-PD |
Consumer Price Index for Prescription Drugs and Medical Supplies |
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|
CS |
Abbreviation for Customer Service |
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|
CSR |
Customer Service Representative |
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|
DC |
Discharge |
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|
DD |
Developmental Disability |
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DI |
Disability Insurance |
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|
Dis |
Disabled |
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|
DME |
Durable Medical Equipment |
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|
DMERC |
Durable Medical Equipment Regional Carrier |
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|
DOB |
Date Of Birth |
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|
DOD |
United States Department of Defense |
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|
DOEH |
Date of Entitlement to Hospital Insurance |
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|
DOES |
Date of Entitlement to Supplementary Medical Insurance |
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|
DVA |
Department of Veterans Affairs |
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|
DWA |
Disabled Working Aged |
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|
DWB |
Disabled Widow's Benefits |
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|
DWI |
Disabled & Working Individual |
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|
EGHP |
Employer Group Health Plan |
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|
EHS |
Abbreviation for Environmental Health & Safety |
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|
EMTALA |
Emergency Medical Treatment and Active Labor Act |
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|
EOB |
Explanation Of Benefits |
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|
EOMB |
explanation of medical benefits |
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|
ERISA |
Employee Retirement Income Security Act |
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|
ESRD |
End Stage Renal Disease (US Federal Program) |
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|
f&a |
Fraud & Abuse |
|
|
FAQ |
Frequently Asked Questions (sometimes Pronounced Fak) |
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|
FAR |
Federal Acquisition Regulation |
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|
FBR |
Federal Benefit Rate |
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|
FDA |
Food Drug Administration |
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|
FEHBP |
Federal Employee Health Benefits Program |
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|
FFS |
Fee-For-Service |
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|
FI |
Fiscal Intermediary |
|
|
FMFIA |
Federal Managers' Financial Integrity Act |
|
|
FMM |
Financial Management Manual |
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|
FOIA |
Freedom of Information Act |
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|
FQHC |
Federally Qualified Health Center |
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|
FSA |
Flexible Savings Account |
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|
GAO |
Government Accounting Office |
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|
GEP |
General Enrollment Period |
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|
GHP |
Group Health Plan, Inc. |
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|
HAS |
Health Savings Account |
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|
HCBWP |
Home & Community Based Waiver Program |
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|
HCFA |
Health Care Financing Administration |
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|
HEDIS |
Health Plan Employer Data and Information Set |
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|
HHQI |
Home Health Quality Initiative |
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|
HHS |
Health & Human Services |
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|
Hib |
Hospital Insurance Benefits |
|
|
HIC |
Health Insurance Claim number used by CMS |
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|
HIPAA |
Health Insurance Portability and Accountability Act of 1996 |
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|
HIPPS |
Health Insurance Prospective Payment System |
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|
HIS |
Indian Health Service |
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|
HRA |
Health Reimbursement Account |
|
|
HRSA |
U.S. Health Resources and Services Administration |
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|
IADL |
Instrumental Activities of Daily Living |
|
|
ICFS/MR |
Intermediate care facilities for the mentally retarded |
|
|
IDIQ |
Indefinite Duration, Indefinite Quantity |
|
|
IEP |
Initial Enrollment Period |
|
|
IRE |
Independent Review Entity |
|
|
JCAHO |
Joint Commission for Accreditation of Health Organizations |
|
|
JCHACO |
Joint Commission on Accreditation of 477 Organizations |
|
|
LIS |
Low-Income Subsidy |
|
|
LMRP |
Local Medical Review Policy |
|
|
LRD |
Lifetime Reserve Days |
|
|
LTC |
Long Term Care Program |
|
|
LTCF |
Long Term Care Facility |
|
|
M C |
Medicare Choice |
|
|
MA |
Medicare Advantage |
|
|
MA-PD |
Medicare Advantage Prescription Drug Plans |
|
|
MAC |
Medicare Appeals Council |
|
|
MAX |
Medicaid Analytic Extract |
|
|
MBD |
Medicaid Beneficiary Database |
|
|
Mbn |
Medicare Benefit Notice |
|
|
MCO |
Managed Care Organization |
|
|
MI |
Medical Insurance |
|
|
MMAP |
Medicare/Medicaid Assistance Program |
|
|
MMDDCCYY |
Month-Month/Day-Day/Century-Century/Year-Year |
|
|
MMDDYY |
MonthMonth/DayDay/YearYear |
|
|
MSA |
Medicare Savings Account |
|
|
MSIS |
Medicaid Statistical Information System |
|
|
MSN |
Medicare Summary Notice |
|
|
MSP |
Medicare Secondary Payor |
|
|
Mtmp |
Medication Therapy Management Program |
|
|
NCI |
National Cancer Institute, USA |
|
|
NCOA |
National Change Of Address |
|
|
NCPDP |
National Council for Prescription Drug Programs |
|
|
NCQA |
National Committee for Quality Assurance |
|
|
NCQHC |
National Committee for Quality Health Care |
|
|
NCVHS |
National Center for Vital and Health Statistics |
|
|
NHCAA |
National Health Care Anti-Fraud Association |
|
|
NHE |
National Health Expenditure |
|
|
NIA |
National Institute on Aging |
|
|
NIH |
NATIONAL INSTITUTE OF HEALTH |
|
|
NIMH |
National Institute of Mental Health |
|
|
NKF |
National Kidney Foundation |
|
|
NMEP |
National Medicare Education Program |
|
|
NPA |
National Pace Association |
|
|
Oac |
Oasis Automation Coordinator |
|
|
OACT |
Office of the Actuary |
|
|
OBQM |
Outcome Based Quality Monitoring |
|
|
OBRA |
Omnibus Budget Reconciliation Act |
|
|
OCR |
Office For Civil Rights (Dept. Of Education) |
|
|
Oec |
Oasis Educational Coordinator |
|
|
OEPI |
Open Enrollment Period for Institutionalized Individuals |
|
|
OGC |
Office of the General Council |
|
|
OIG |
Office of the Inspector General |
|
|
OIS |
Office of Information Systems |
|
|
OMB |
Office of Management and Business |
|
|
OP |
Overpayment |
|
|
OP |
Outpatient |
|
|
OPM |
Office of Personnel Management |
|
|
OPPS |
Outpatient Prospective Payment System |
|
|
P&T |
Pharmaceutical and Therapeutic |
|
|
PACE |
Program for All Inclusive Care for the Elderly |
|
|
PBA |
Pharmacy Benefit Administrator |
|
|
PBMs |
pharmacy benefit managers |
|
|
PBP |
Plan Benefit Package |
|
|
PDP |
Private Prescription Drug Plan |
|
|
PDSC |
Phased-Down State Contribution |
|
|
PEBS |
Personal Earnings & Benefit Statement |
|
|
PFFS |
Private Fee-For-Service Plan |
|
|
Phrma |
Pharmaceutical Manufacturers and Researchers of America |
|
|
PO |
Post Office |
|
|
PPV |
Pharmaceutical Prime Vendor |
|
|
PRO |
Peer Review Organization |
|
|
PSO |
Provider-Sponsored Organization |
|
|
Q&A |
Questions & Answers |
|
|
QCP |
Quality Control Program |
|
|
QDWI |
Qualified Disabled and Working Individual |
|
|
QDWIS |
Qualified Disabled and Working Individuals |
|
|
QI |
Quality Indicator |
|
|
QIES |
Quality Improvement Evaluation System |
|
|
QIO |
Quality Improvement Organization |
|
|
QIS |
Qualified Individuals |
|
|
QMB |
Qualified Medicare Beneficiary |
|
|
QWDI |
Qualified Working Disabled Individuals |
|
|
RDF |
Renal Dialysis Facility |
|
|
RDS |
The Retiree Drug Subsidy Program |
|
|
RDS NUMBER |
see Plan Sponsor number |
|
|
REACH |
Regional Education About Choices in Health |
|
|
RFA |
Reason for Assessment |
|
|
RHHI |
Regional Home Health Intermediary |
|
|
RNHCI |
Religious NonMedical 477 Institution |
|
|
RO |
Regional Office |
|
|
ROC |
Resumption of Care |
|
|
ROC |
Report of Contact |
|
|
RRB |
Railroad Retirement Board |
|
|
s&c |
Survey & Certification |
|
|
SCHIP |
State Child Health Insurance Program |
|
|
SEP |
Special Enrollment Period |
|
|
SGA |
Substantial Gainful Activity |
|
|
SHI |
Supplemental Health Insurance |
|
|
SHIP |
Supplemental Health Insurance Programs |
|
|
SHIP |
State Health Insurance Assistance Program |
|
|
SLIMB |
Specified LowIncome Medicare Beneficiary |
|
|
SLMB |
Specified Low-Income Medicare Beneficiary |
|
|
SNF |
Skilled Nursing Facility |
|
|
SOB |
Statement of Benefits |
|
|
SPAP |
State Pharmaceutical Assistance Program |
|
|
SPD |
Summary Plan Description |
|
|
SPOC |
Single Point Of Contact |
|
|
SS |
Social Security |
|
|
SSA |
Social Security Administration |
|
|
SSA |
State Survey Agency |
|
|
ssa |
Social Security actuaries |
|
|
SSARA |
SSA Reform Act of 1994 |
|
|
SSDI |
Social Security Disability Insurance |
|
|
SSN |
Social Security Number |
|
|
SSSGS |
Similarly Sized Subscriber Groups |
|
|
TBD |
To Be Determined |
|
|
TDD |
Telecommunications Device for the Deaf |
|
|
TEP |
Technical Experts Panel |
|
|
TITLE I |
Grants to States for old age assistance & medical assistance for the aged |
|
|
TITLE II |
Federal old age, survivors & disability insurance benefits |
|
|
TITLE IV |
Grants to States for aid & services to needy famlies with children |
|
|
TITLE X |
Grants to States for aid to the blind |
|
|
TITLE XIV |
Grants to States for aid to the permanently & totally disabled |
|
|
TITLE XIX |
Grants to States for medical assistance programs |
|
|
TITLE XVIII |
Health Insurance |
|
|
TITLE XX |
State operated home 477 entitlement program |
|
|
TITLE XXI |
State Child Health Programs |
|
|
TPN |
Total Parenteral Nutrition |
|
|
TrOOP |
True Out-Of-Pocket |
|
|
TTY |
Text Telephones |
|
|
TWWIA |
Ticket to Work & Work Incentives Act |
|
|
U&C |
Usual and customary |
|
|
UMW |
United Mine Workers |
|
|
UPS |
United Parcel Service, Inc. |
|
|
URAC |
Utilization Review Accreditation Commission |
|
|
USP |
U.S. Pharmacopoeia |
|
|
usps |
United States Postal Services |
|
|
VDS |
Voluntary Data Sharing |
|
|
VDSA |
Voluntary Data Sharing Agreement |
|
|
XIV |
Title 14 Grants to States for Aid to the Permanently & Totally Disabled |
|
|
XIX |
Title 19 Grants to States for Medical Assistance Programs |
|
|
XIXED |
Title 19 Entitlement Date |
|
|
XVI |
Title 16 Grants to States for Aid to the Aged, Blind or Disabled or Aid & Medical Assistance for the |
|
|
XVIII |
Title 18 Medicare |
|
|
XX |
Title 20 State operated home hea lth care entitlement program |
|
|
XXI |
Title 21 State Child Health Program |
|
|
Y2K |
Year 2000 |
|
|
YOB |
Year Of Birth |
|
|
YR |
Year |
|
|
YYYY |
Four-Digit Year |
|
|
ZIP 4 |
9 digit ZIP Code Plan |
|