HIPAA Workshop Acronym List by qqv75767

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									                                 HIPAA Workshop Acronym List
Claim form types providers currently use to bill DHS:
               ADA American Dental Association claim form
         HCFA 1500 Health Care Financing Administration claim form
                 RSI Residential Services Invoice claim form
              UB-92 Universal Biller claim form

MN-ITS Electronic Transactions (ANSI Transactions Sets):
                270 Eligibility inquiry
                271 Eligibility response
                276 Claim status inquiry
                277 Claims status response
                278 Referral and authorization (prior authorizations and service agreements—DOES NOT
                     include waiver and day training and habilitation service agreements at this time)
                820 Premium payment
                834 Enrollment transaction
                835 Health care claim payment and remittance advice
                837 Health care claim

Claim form types used to bill DHS on MN-ITS:
               837D Dental claim form
          837I/LTC Institutional health claim form used by long term care provider billers or RSI billers
                837I Institutional health care claim form used by UB-92 billers
               837P Professional health care claim form used by current HCFA-1500 claim form billers

                 A      Add key
             ANSI       American National Standards Institute
          ASC X12       Accredited Standards Committee X12 N* (*N Insurance Subcommittee)
            CDMI        Care Delivery Management Incorporated
            CLIA        Clinical Laboratory Improvement Amendments
             CMN        Certificate of Medical Necessity
             CMS        Centers for Medicare & Medicaid Services
             COB        Coordination of Benefits
   COP1, COP2, etc.     Claim Level Other Payer
                 D      Delete key
             DHS        Department of Human Services
             DME        Durable Medical Equipment
          DMERC         Durable Medical Equipment Regional Carrier
               DX       Diagnosis
              EDI       Electronic Data Interchange
              EIN       Employer Identification Number
             EOB        Explanation of Benefits
           EOMB         Explanation of Medical Benefits
 EPO claim service Epotin blood test results info
                lines
             EPSDT Early Periodic Screening and Development Testing (this is now known as C&TC-Child
                      and Teen Check-up)
               ESRD End Stage Renal Disease
                EVS Eligibility Verification System
                  F2 International units of time for billing purposes on Services screen
            HCPCS Health Care Financing Administration Common Procedural Coding System
    HH1, HH2, etc. Home Health provider(s) listed on Claim Information screen in the Home Health Care
                      Plan Information box
             HIPAA Health Insurance Portability and Accountability Act of 1996
         ICD-9-CM International Classification of Disease, Ninth Revision, Clinical Modification
                  ID Identification
                 ITS Information Transfer System
         L1, L2, etc. A billing line on the Services tab screen on a claim transaction in MN-ITS that has been
                      saved for later submission
                LOP Line item you want to look at to record other payer
 (Service tab screen)
                LTC Long Term Care
             MHCP Minnesota Health Care Programs
       MIA Counts Medicare Inpatient Adjudication days
                  MJ Minutes increment of time for billing purposes on Services screen
         mmddyyyy Format used to enter a date onto claim forms—example: January 1, 2003 could be
                      01012003 or 01-01-2003 or 01/01/2003
              MMIS Medicaid Management Information System
MN-ITS Interactive The new way to bill individual claims directly to DHS via the Internet—this will replace
                      ITS software billing for most providers
            MN-ITS Minnesota Information Transfer System—new web-based interactive tool in Minnesota
               MOD Modifier
            NCPDP National Council for Prescription Drug Programs
                NDC National Drug Code
                NSF National Standard Format
         P1, P2, etc. Used for provider to show if there was another payer who paid something on a claim
                  PA Prior Authorization
              PMAP Pre-paid Medical Assistance Program
                PMI Person Master Index
                  PO Other payer you have listed on a line item that has gotten paid something for the service
                      you are now billing for
                POS Point of Sale—this is a method that pharmacies use to bill for services
 Provider PDF files Printer friendly files with DHS/MHCP information
              PROV Provider
                  RA Remittance Advice
           RSN code Reason code
                RX# Prescription number
                  SA Service Agreement
                TCN Transaction Control Number
              TPA      Trading Partner Agreement
               UN      Units increment of time for billing purposes on Services screen
             UPIN      Unique Physician Identification Number
  X12 4010A1 batch     New HIPAA compliant batch format—for providers who will do batch billing that is
           format      HIPAA compliant using non-DHS software or a clearinghouse to bill DHS
              X12      The new HIPAA-compliant standard format for batch health care transactions

RA—Remittance Advice—acronyms specific to the RA
           A Units Adjusted Units
        ADJ AMT Adjustment Amount
      ADJ GROUP Adjustment Group (there are five different valid codes for this field and they are):
                        CO        Contractual Obligation
                        CR        Correction and Reversal
                        OA        Other Adjustment
                        PI        Payer Initiated Reduction
                        PR        Patient Responsibility
     ADJ REASON Adjustment Reason
       AUTH NBR Authorization Number
    CHK/EFT NBR Check or Electronic Funds Transfer
       Doc ID Nbr Documentation Identification Number
        FROM DT From Date—beginning date of service
          ID NBR Identification Number
               LI Line Item number designation
               MI Middle Initial
           P Units Paid Units
   PAT CTRL NBR Patient Control Number
    PAYER CLAIM Payer Claim Number
             NBR
        PROC CD Procedure Code
      PROD DATE Production Date
       PROV ADJ Provider Adjustment Reason
         REASON
 PROV CTRL NBR Provider Control Number
          PYMNT Payment
 R PROV NUMBER Rendering Provider Number
 RENDERING NBR Rendering Number
             TCN Transaction Control Number
           TO DT End date of the service
     VENDOR NBR Vendor number

								
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