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Mode 4010 wk 2

4010 2Terms and Abbreviations

ASP Application Service Provider
DDE Direct Data Entry
DSL Digital Subscriber Line
EDI Electronic Data Interchange
EFT Electronic Funds Transfer
EIN Employer Identification Number
ERA Electronic Remittance Advice
ICD-10 CM International Classification of Diseases Tenth Revision, Clinical Modification
ICD-9 CM International Classification of Diseases Ninth Revision, Clinical Modification
NEC Not Elsewhere Classifiable
NOS Not Otherwise Specified
NPI National Provider Identifier (number)
NSF National Standard Format
PHI Protected Health Information
PMS Practice Management System
Clearinghouse An independent organization that receives insurance claims from the physician's office, performs software edits, and redistributes the claims electronically to various insurance carriers.
Code sets any set of codes with their descriptions used to encode data elements such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes
Covered entity an entity that transmits health information in electronic form in connection with a transaction covered by HIPPA
Data elements medical code sets used uniformly to document why patients are seen and what is done to them during their encounter
Digital subscriber line A high-speed connection through a telephone line jack and usually a means of accessing the Internet
Direct data entry Keying claim information directly into the payer system by accessing over modem dial-up or DSL
Electronic Data interchange the process by which understandable data items are sent back and forth via computer linkages between tow or more entities that function alternatively as sender and receiver
Electronic funds transfer is a paperless computerized system that enables funds to be debited, credited, or transferred and eliminates the need for personal handling of checks
Electronic Remittance Advise An online transaction about the status of a claim
Encryption is used to assign a code to represent data
HIPAA Transaction and Code Set Rule was developed to introduce efficiencies into the health care system/ this regulation under HIPAA defines the standardized methods for transmitting electronic health information
National standard format The name of the standardization of data to reduce paper and have more accurate information and efficient organization
Real time Online interactive communication between two computer systems allowing instant transfer of information
Trading partner agreement Contract between the provider and a clearinghouse that submits the electronic claims on behalf of the provider
Medical Necessity The performance of services and procedures that are consistent with the diagnosis in accordance with standards of good medical practice performed at proper level, and provided in the most appropriate setting
Root word The word used to look up the code correctly the first time, meaning the condition, for the ICD-9 disease, sign, symptom, the key word to the problem
Chronic A medical condition persisting over a long period of time
Acute A medical condition that runs a short but relatively severe course
Encoder Add-on software to practice management systems that can reduce the time it takes to build or review insurance claims before batch transmission to the carrier
Created by: SSchabow