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Following is a list of acronyms commonly used in the administration, policies or procedures of Utah’s
Medicaid Program:

AFDC            Aid to Families with Dependent Children

ALOS            Average Length of Stay

ANSI            American National Standards Institute

BCRP            Bureau of Coverage and Reimbursement Policy

BEP             Bureau of Eligibility Policy

BFS             Bureau of Financial Services

BMO             Bureau of Medicaid Operations

BVS             Bureau of Vital Statistics

CFR             Code of Federal Regulations

CHEC            Child Health Evaluation and Care

CHIP            Child Health Insurance Program

CHP             Chiropractic Health Plans

CLIA            Clinical Laboratory Improvement Amendments

CMS             Centers for Medicare & Medicaid Services

CPAS            Claims Processing Assessment System

CPT             Current Procedural Terminology

CRP             Coverage and Reimbursement Policy

DRA             Deficit Reduction Act

DFCS            Division of Child and Family Services

DHCF            Division of Health Care Financing
DHS     Department of Human Services

DOH     Department of Health

DRG     Diagnosis Related Group

DUR     Drug Utilization Review

DWS     Division of Workforce Services

EDI     Electronic Data Interchange

EOB     Explanation of Benefits

EOMB    Explanation of Medicare Benefits

EPLS    Excluded Party List System

EPSDT   Early Periodic Screening Diagnosis and Treatment

EREP    Electronic Resource and Eligibility Product

FDA     Food and Drug Administration

FFP     Federal Financial Participation

FFS     Fee for Service

FID     Fraud Investigation Database

FPL     Federal Poverty Level

FR      Federal Register

GRAMA   Government Records Access and Management Act

HCBS    Home and Community Based Services

HCPCS   Healthcare Common Procedure Coding System

HHA     Home Health Agency

HHS     Department of Health and Human Services (Federal)

HIPDB   Health Integrity and Protection Data Bank

HIPPA   Health Insurance Portability and Accountability Act

HMO     Health Maintenance Organization
HPR     Health Program Representative

HUR     Hospital Utilization Review

ICF     Intermediate Care Facility

ID#     Identification Number

IPA     Independent Practice Association

IPIA    Improper Payments Information Act of 2002

MCO     Managed Care Organization

MDC     Medical Diagnostic Category

MEQC    Medicaid Eligibility Quality Control

MFCU    Medicaid Fraud Control Unit

MFR     Mandated Federal Review

MFU     Medicaid Fraud Unit, now the MFCU

MHC     Managed Health Care

MIB     Medicaid Information Bulletin

MIC     Medicaid Integrity Contractor

MIG     Medicaid Integrity Group

MHF     Medicaid and Health Financing

MIP     Medicaid Integrity Program

MMCS    Medicaid Managed Care System

MMIS    Medicaid Management Information System

MOU     Memorandum of Understanding

MPI     Medicaid Program Integrity

NCPDP   National Council of Prescription Drug Programs

NDC     National Drug Code

NPDB    National Practitioner Data Base
NPI     National Provider Identifier

NTM     Non-Traditional Medicaid

OBRA    Omnibus Budget Reconciliation Act

OIA     Office of Internal Audit

OIG     Office of the Inspector General

OMIG    Office of Medicaid Inspector General

OIT     Office of Information Technology

ORS     Office of Recovery Services

ORSIS   Office of Recovery Services Information System

PPACA   Patient Protection and Affordable Care Act

PCN     Primary Care Network

PCP     Primary Care Physician

PERM    Payment Error Rate Measurement

PMHP    Prepaid Mental Health Plan

POS     Point of Sale

PPO     Preferred Provider Organization

PRO     Peer Review Organization

QMB     Qualified Medicare Beneficiary

RAC     Recovery Audit Contractor

RBRVS   Resource-Based Relative Value Scale

SNF     Skilled Nursing Facility

SPR     System Performance Review Requirements

SSI     Supplemental Security Income

SURS    Surveillance Utilization Review Subsystem

TANF    Temporary Assistance to Needy Families
TCN    Transaction Control Number (Claim number)

TPL    Third Party Liability

UHA    Utah Hospital Association

UHCA   Utah Health Care Association

UHIN   Utah Health Information Network

UMA    Utah Medical Association

UMU    Utilization Management Unit

WIC    Special Program for Women, Infants, and Children

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