Acronyms
HIPAA
What is the Health Insurance Portability and Accountability Act
In what year was the Medicaid and CHIP Managed Care Final Rule published?
What is 2016
999
What is the file level document used to acknowledge the initial receipt of an electronic file and whether the claim was accepted or rejected at the HIPAA level
CPT
What is Current Procedural Terminology
HHS
What is Department of Health and Human Services
ISCA
What is an Information Systems Capabilities Assessment
Health Plan claims that have been adjudicated, submitted and accepted by the Fiscal Agent are known as what?
What are encounters
835
What is a HIPAA compliant claim response file provided to providers or managed care entities
DRG
What is Diagnosis Related Group
NCQA
What is National Committee for Quality Assurance
HCQI
What is Health Care Quality Improvement
A continuous count of days in a calendar year is known as a what?
What is a Julian Date
834
What is a HIPAA compliant benefit enrollment and maintenance documentation
HCPCS
What is Healthcare Common Procedure Coding System
CMS
What is the Centers for Medicare and Medicaid Services
MFCU
What is the Medicaid Fraud Control Unit
A record of Health Plan expenditures typically displayed by month.
What is a Cash Disbursement Journal (CDJ)
277
What is a claim status response file (returned in response to a 276 inquiry)
EPSDT
What is Early and Periodic Screening, Diagnostic, and Treatment Program
DOJ
What is the Department of Justice
HEDIS
What is the Healthcare Effectiveness Data and Information Set
Also known as a capitation payment
What is per member per month (PMPM)
837
What is a HIPAA compliant standard claim format used to submit electronic health care claims. Professional (P), Institutional (I) and Dental (D)
PCP
What is Primary Care Provider
GAO
What is the Government Accountability Office