HIPAA and DHFS Acronyms, Terms, and Definitions

DHS Acronyms and Term Definition List 

Acronyms and specialized terminology used by public and private agencies are timesaving, shorthand ways for them to communicate lengthy titles and basic concepts. To the uninitiated listener or reader, however, they seem to comprise a foreign language or simply bureaucratic jargon.

This Glossary is meant to help persons contacting the Department of Health Services who need a quick reference to terms, acronyms and abbreviations commonly used by the Department. 

List of terms

Use your browser's back button to return to "HIPAA Now".

HIPAA Acronyms and Term Definition List

ADA - American Dental Association

Administrative Simplification - The process to improve efficiency of health care delivery by standardization of electronic data exchange

AFEHCT - Association for Electronic Health Care Transactions

AMA - American Medical Association

ANSI -American National Standards Institute - The highest level national standards organization that coordinates voluntary standards in the United States. ANSI does not develop standards, but approves a standard when the sanctioned development organizations prove substantial agreement from those affected by the proposed standard. ANSI currently endorses over 8,500 standards

ASC - Accredited Standards Committees - Accredited by ANSI to develop national standards for various industries

Ambulatory Surgical Center

ASC X12 - Subcommittee - Accredited by ANSI to develop national standards for various industries. Developed implementation guides

BCBSA - Blue Cross and Blue Shield Association

CDT - Current Dental Terminology

Code set - A group of codes with pre-defined meanings, such as CPT, revenue codes, and diagnosis codes

Covered entity - Is one of the following: health plan, health care clearinghouse, or health care provider who transmits or receives any health information in electronic form

CPT - 4 - Current Procedural Terminology, 4th edition

Data element - The smallest named unit of information in the ASC X12 standards. An element is almost always defined as variable length and may be optional or mandatory within the data segment

DFI - Depository Financial Institution

DHHS - Department of Health and Human Services

DISA - Data Interchange Standards Association, Inc.

DSMO - Designated Standard Maintenance Organization - An organization designated by the Secretary to maintain standards, receive and process requests for adopting a new standard or modifying an adopted standard

EDI - Electronic Data Interchange - Computer to computer exchange of machine-readable data in standard format

EFT - Electronic Funds Transfer

EIN - Employer Identification Number

EMC - Electronic Media Claim - Sending claim information electronically to a payer for reimbursement

Federal Register - The document that has been signed into law

HCFA - Health Care Financing Administration

HCPCS - HCFA Common Procedure Coding System

Health care clearinghouse - A public or private entity that does either of the following: 

1) Processes or facilitates the processing of information received from another entity in a  nonstandard format or containing nonstandard data content into standard data elements or a standard transaction
2) Receives a standard transaction from another entity and processes or facilitates the processing of information into nonstandard format or nonstandard data content for receiving entity.

HHS - Department of Health and Human Services

HIPAA - Health Insurance Portability and Accountability Act - Common name for Public law 104-191 containing government mandates for the health care industry, including EDI administrative simplification requirements

HL7 - Health Level 7

IG - Implementation Guide

ICD-9 CM - International Classification of Diseases, 9th Revision (clinical, surgical, diagnosis, procedures)

Implementation date - The date a covered entity must comply with a final rule compliance

Implementation guide - Defines the electronic format and values for each data element within a transaction

NCPDP - National Council for Prescription Drug Program

NDC - National Drug Codes

NMEH - National Medicaid EDI HIPAA

NPI - National Provider Identifier

NPRM - Notice of proposed rule making

NUBC - National Uniform Billing Committee - The organization generally recognized as the authority to determine data content, such as revenue codes for facility health care claims. The NUBC is designated as an advisory group to DHHS under HIPAA legislation

NUCC - National Uniform Claim Committee

PHI - Personal Health Information

Portability -  does not mean that a specific health plan can be carried from one job to another. Instead, it means once health insurance is obtained, evidence of that insurance can reduce or eliminate a pre-existing medical condition exclusion period that may be imposed on the health plan.

Small health plan - A health plan with annual receipts of $5 million or less

SNIP - Strategic National Implementation Process

Standard setting organization - An organization accredited by the American National Standards Institute (ANSI) that develops and maintains standards for information transactions.

TAG - Technical Advisory Group
           Technical Assessment Groups

TG - Task Group

Trading partner - An entity involved in exchanging electronic data, usually the sender or receiver

Transaction - The exchange of information between two parties to carry out financial or administrative activities related to healthcare, such as claims, remittance advice or an eligibility inquiry

Translator - Software that provides the framework for translating data between a trading partner's application system format and a standard format. A translator usually provides for version control and acknowledgement of transactions. A translator does not usually include physical transmission of the data

VAN - Value Added Network

WEDI - Work Group for Electronic Data Interchange - A health care industry task force designated as an advisory group to DHHS under the HIPAA legislation.

WG - Work Group

X12 - Standards Setting Organization

X12N - Insurance Division of X12

837 (identifying transaction number) - Electronic health care claim or adjustment - professional, institutional, and dental

835 (identifying transaction number) - Electronic remittance advice

834 (identifying transaction number) - Electronic plan enrollment - The notification to the insurance carrier of enrollment/disenrollment in to a health care plan such as enrollment/disenrollment in the Wisconsin Medicaid managed care program.

820 (identifying transaction number) - Electronic plan premium payments - The transmission of payment information about the transfer of funds, or detailed remittance information about individuals for whom premiums are being paid, from the entity that is arranging for the provision of health care coverage payments for an individual to a health plan

278 (identifying transaction number) - Electronic referral certification and authorization - A request and response for the review of health care to obtain an authorization for health care

277 (identifying transaction number) - Electronic health claim status response

276 (identifying transaction number)  - Electronic health claim status inquiry

271 (identifying transaction number) - Electronic eligibility response

270 (identifying transaction number) - Electronic eligibility inquiry

Last updated:  July 22, 2009