Glossary

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

Under HIPAA, this is the smallest named unit of information in a transaction.

Under HIPAA, this is the specific instructions for implementing a standard.

Under HIPAA, this is those data elements that provide or control the enveloping or hierarchical structure, or assist in identifying data content of, a transaction.

Under HIPAA, this means employees, volunteers, trainees, and other persons under the direct control of a covered entity, whether or not they are paid by the covered entity. Also see Part II, 45 CFR 160.103.

Under this system of calculating summary measures, the actuarial balance is defined as the difference between the arithmetic means of the annual cost rates and the annual income rates, with an adjustment included to account for the offsets to cost that are due to (1) the starting trust fund balance and (2) interest earned on the trust fund.

Unless otherwise qualified, all wages from employment and net earnings from self-employment, whether or not taxable or covered.

Used when no comparable, existing test is available. Carrier specific amounts are used to establish a national limitation amount for the following year.

Using information on a claim or other information requested to support the services billed, to make a determination.

Usually a drug or vaccine made from a live product and used medically to diagnose, prevent, or treat a medical condition. For example, a flu or pneumonia shot.