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Find out more about CACIHealth
Select a letter to view that part of the alphabet. If linked (underlined) you can click on the term to see it's definition in the Glossary.
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
A
AAHC - The American Accreditation HealthCare Commission, formerly
known as Utilization Review Accreditation (URAC)
AAHP - American Association of Health Plans, formerly GHAA and AMCRA
AAPCC - adjusted average per capita cost
AAPPO - American Association of Preferred Provider Organizations
ABMS - American Board of Medical Specialties
ACR - adjusted community rating
ACRP - adjusted community rate proposal
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
AHP - accountable health plan
ALOS - average length of stay
AMA - American Medical Association
APT - admissions per thousand
ASO - administrative services only
ASR - age/gender rate
AUR - ambulatory utilization review
AWP- average wholesale price or any willing provider
C
CAC - certified alcoholism counselor
Cap - capitation
CHAMPUS - Civilian Health and Medical Program of the Uniformed Services
CMP - competitive medical plan or certified medical planner
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 - dual choice
DCA - deferred compensation administrator
DCI - duplicate coverage inquiry
DME - durable medical equipment
DO - doctor of osteopathy
DOB - date of birth
DOH - Department of Health, now HHS
DOS - date of service
DPR - drug price review
DPT - days per thousand
DRG - diagnosis related group
DSMIV - Diagnostic and Statistical Manual, Fourth Edition
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
FAS 106 - Financial Accounting Standard 106
FFS - fee-for-service
FSA - flexible spending account
H
HCFA - Health Care Financing Administration
HCFA 1500 - a universal billing form developed by HCFA
HCPCS - HCFA Common Procedural Coding System
HCPP - health care pre-payment plan
HEDIS - Health Plan Employer Data and Information Set
HHA - home health agency
HHS - Department of Health and Human Services
HIPAA - Health Insurance Portability and Accountability Act
HIAA - Health Insurance Association of America
HIPC - health insurance purchasing cooperative
HMO - health maintenance organization
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,
Ninth Edition (Clinical
Modification)
ICF - intermediate care facility
IMO - integrated multiple option
IPA - individual practice association
IPO - integrated provider organization
IME - independent medical evaluation
ISN - integrated service network
J
JCAHO - Joint Commission on Accreditation of Healthcare 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
MedPAC - Medicare Payment Assessment Commission
Medsupp - Medicare supplement insurance
MH/CD - mental health/chemical dependency
MH/SA - mental health/substance abuse
MRI - magnetic resonance imaging
MSHJ - medical staff hospital joint venture
MSO - management service organization
MSS - medical social services
MSW - masters 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 for Quality Assurance
NDC - National Drug Code
Non-par - nonparticipating provider
NPA - National Prescription Audit
NPA - non-par approved
NPN - non-par not approved
O
OA - open access
OOA - out of area
OON - out of network
OOP - out of pocket costs/expenses
OSHA - Occupational Safety and Health Administration
OTC - over the counter
P
P&T - pharmacy and therapeutics
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
POS - point of service
PPRC - Physician Payment Review Commission (no longer exists)
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
Retro - retrospective rate derivation
RFP - request for proposal
RMC - rating method code
S
SCR - standard class rate
SGA - standard industry code
SG&A - selling, general and administrative expenses
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
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
UR/QA - utilization review/quality assurance
W
WEDI - Workgroup for Electronic Data Interchange