Glossary
AcronymsTerm | Definition Sort ascending |
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TRUE NEGATIVES | These are eligibles who have not received any services through the managed care plan, as evidenced by the absence of a medical record and any encounter data. True negatives signify potential access problems, and should be investigated by the managed care plan. |
MEDICARE SAVINGS PROGRAMS | There are programs that help millions of people with Medicare save money each year. States have programs for people with limited incomes and resources that pay Medicare premiums. Some programs may also pay Medicare deductibles and coinsurance.You can apply for these programs if:You have Medicare Part A (Hospital Insurance). (If you are eligible for Medicare Part A but don’t think you can afford it, there is a program that may pay the Medicare Part A premium for you.),you are an individual with resources of $4,000 or less, or are a couple with resources of $6,000 or less. Resources include money in a savings or checking account, stocks, or bonds and You are an individual with a monthly income of less than $1,031, or a couple with a monthly income of less than $1,384. Income limits will change slightly in 2004. If you live in Hawaii or Alaska, income limits are slightly higher.Note: If your income is less than the amounts listed above, you may qualify for Medicaid. |
ENROLLMENT/PART A | There are four periods during which you can enroll in premium Part A: Initial Enrollment Period (IEP), General Enrollment Period (GEP), Special Enrollment Period (SEP), and Transfer Enrollment Period (TEP).
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X12 278 | The X12 Referral Certification and Authorization transaction. Version 4010 of this transaction has been included in the HIPAA mandates. |
X12 274 | The X12 Provider Information transaction. |
X12/PRB | The X12 Procedures Review Board. |
X12 820 | The X12 Payment Order & Remittance Advice transaction. Version 4010 of this transaction has been included in the HIPAA mandates. |
X12 275 | The X12 Patient Information transaction. This transaction is expected to be part of the HIPAA claim attachments standard. |
X12 IHCEBI & IHCEBR | The X12 Interactive Healthcare Eligibility & Benefits Inquiry (IHCEBI) and Response (IHCEBR) transactions. These are being combined and converted to UN/EDIFACT Version 5 syntax. |
X12 IHCLME | The X12 Interactive Healthcare Claim transaction. |