Glossary

A system established under HIPAA for accepting and tracking change requests for any of the adopted HIPAA transaction standards via a single web site. See www.hipaa-dsmo.org.

Under HIPAA, this is the exchange of information between two parties to carry out financial or administrative activities related to health care.

External entity with whom business is conducted, i.e. customer. This relationship can be formalized via a trading partner agreement. (Note: a trading partner of an entity for some purposes, may be a business associate of that same entity for other purposes.)

A Third Party Use occurs when a third party from another organization is given permission to use data originally obtained from CMS by the original requestor.

Business associate that performs claims administration and related business functions for a self-insured entity.

An entity required to make or responsible for making payment on behalf of a group health plan.

The conditions required to meet this test are as follows: (1) If the trust fund ratio for a fund exceeds 100 percent at the beginning of the projection period, then it must be projected to remain at or above 100 percent throughout the 10-year projection period; (2) alternatively, if the fund ratio is initially less than 100 percent, it must be projected to reach a level of at least 100 percent within 5 years (and not be depleted at any time during this period), and then remain at or above 100 percent throughout the rest of the 10-year period. This test is applied to trust fund projections made under the intermediate assumptions.

Summarized income rates and cost rates are calculated for each of 66 valuation periods within the full 75-year long-range projection period under the intermediate assumptions. The first of these periods consists of the next 10 years. Each succeeding period becomes longer by 1 year, culminating with the period consisting of the next 75 years. The long-range test is met if, for each of the 66 time periods, the actuarial balance is not less than zero or is negative by, at most, a specified percentage of the summarized cost rate for the same time period. The percentage allowed for a negative actuarial balance is 5 percent for the full 75-year period and is reduced uniformly for shorter periods, approaching zero as the duration of the time periods approaches the first 10 years. The criterion for meeting the test is less stringent for the longer periods in recognition of the greater uncertainty associated with estimates for more distant years. This test is applied to trust fund projections made under the intermediate assumptions.

A type of insurance that is in force for a specified period of time.

Professional services given to a patient through an interactive telecommunications system by a practitioner at a distant site.