Abbreviations – James Carvin Insurance

Deciphering the Industry Codes

Even industry professionals lose track of all the abbreviations and definitions of terms used in the health and life insurance business. This growing list, compiled by James Carvin, is for everyone, seasoned or new.

AAA – Area Agency on Aging
AAC – Actual Acquisition Cost
ABA – Applied Behavioral Analysis
ABE – Agents, Brokers and Broker Entities
ABP – Alternative Benefit Plan
ACA – Affordable Care Act
ACC – Accountable Care Collaborative
ACF – Administration for Children & Families
ACIP – Advisory Committee Practice (Centers for Disease Control & Prevention)
ACO – Accountable Care Organization
ACS – American Community Survey
ADA (1973) – Americans with Disabilities Act
ADA (1975) – Age Discrimination Act
ADD – Attention Deficit Disorder
ADHD – Attention Deficit Hyperactivity Disorder
ADL – Activity of Daily Living
AEP – Annual Enrollment Period
AFDC – Aid to Families with Dependent Children
AFMO – Aggregator Field Marketing Organization
AHCCCS – Arizona Health Care Cost Containment System
AHIP – American’s Health Insurance Plans (training certifications)
AHRQ – Agency for Healthcare Research & Quality
AIDS – Aquired Immune Deficiency Syndrome
AIR – Assumed Investment Rate
AKS – Anti Kickback Statute
ALM – Agent Lifecycle Management
ALS – Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)
AMA – American Medical Association
AML – Anti Money Laundering
AMP – Average Manufacturer Price
ANCSA – Alaska Native Claims Settlement Act
ANOC – Annual Notice of Change
AOA – Agent Online Application enrollment
AOC – Assignment of Commissions
AOR – Agent of Record
APC – Ambulatory Payment Classification
APE – Agent Portal External
APIs – Application Programming Interfaces
APRN – Advanced Practice Registered Nurse
APS – Annual Person Summary
APTC – Advance Premium Tax Credit
ARP – American Rescue Plan
ARPA – American Rescue Plan Act
ARRA – American Recovery & Reinvestment Act
ARTS – Addiction and Recovery Treatment Services
ASAM – American Society of Addiction Medicine
ASC – Ambulatory Surgical Center
ASP – Average Sales Price
ASPE – Assistant Secretary of Planning and Evaluation
AV – Actuarial Value
AVS – Asset Verification System
AWP – Average Wholesale Price

BA – Business Associate(s)
BAR – Batch Auto Re-enrollment
BAV – Bonus Accumulation Value
BBA97 – Balanced Budget Act of 1997
BCBSFL – Blue Cross Blue Shield of Florida (Florida Blue)
BHH – Behavioral Health Homes
BHO – Behavioral Health Organization
BHP – Basic Health Program
BIP – Balancing Incentive Payment Program
BMI – Body Mass Index
BNP – Banco National de Paris
BNPP – Banco National de Paris and Paribas
BNPIMAD – Banco National de Paris Multi Asset Diversified
BOE – Basis of Eligibility
BOB – Book of Business
BOR – Broker of Record
BRC – Business Reply Card
BRFSS – Behavioral Risk Factor Surveillance System
BSA – Bank Secrecy Act

CAA – Consolidated Appropriations Act (2023)
CACs – Certified Application Counselors, volunteers
CAD – Coronary Artery Disease
CAM – Customer Acquisition Marketing
CAH – Critical Access Hospital
CAHMI – Child and Adolescent Health Measurement Initiative
CAHPS – Consumer Assessment of Healthcare Providers & Systems
CARF – Commission on Accreditation of Rehabilitation Facilities
CARL – CIGNA Agent Resource Line
CARTS – CHIP Annual Reporting Template System
CBES – Childrens Health Budget and Expenditure System
CBO – Congretional Budget Office
CBT – Cognitive Behavioral Therapy
CCBHC – Certified Community Behavioral Health Clinic
CCIIO – Consumer Information & Insurance Oversight
CCIP – Chronic Care Improvement Plan
CCN – CMS Certification Number
CCO – Coordinated Care Organization
CCPD – Continuous Cycling Peritoneal Dialysis
CCR – Cost to Charge Ratio
CCW – Chronic Condition Data Warehouse
CDC – Centers for Discease Control & Prevention
CDD – Customer Due Diligence Rule
CDL – Clinical Diagnostic Laboratory
CDOs – CAC Designated Organizations
CDP – Common Disaster Provision
CDPS – Chronic Illness and Disability Payment System
CDR – Consumer Data Respondent
CDT – Current Dental Terminology
CEHRT – Certified Electronic Health Record Technology
CEU – Continuing Education Unit
CF – Conversion Factor
CFACTS – CMS FISMA Controls Tracking System
CHAMPVA – Civilian Health and Medical Program – Dept. of Veterans Affairs
CHF – Congestive Heart Failure
CHIP – Children’s Health Insurance Program
CHIPRA – Children’s Health Insurance Program Re-Authorization Act
CHNA – Community Health Needs Assessment
CHP – Capital Health Plan
CIA – Children’s Insurance Agreement
CiC – Change in Circumstances
CICA – Consumer Insurance Contracts Act
CICA – Citizens Insurance Corporation of America
CIN – Client ID Number
CIP – Customer Identification Program
CLAS – Culturally & Linguistically Appropriate Services
CLD – Chronic Lung Disease
CLI – Catastrophic Loss Index
CLI – Certificate of Liability Insurance
CLI – Continental Life Insurance (Aetna)
CLIA – Clinical Laboratory Improvement Ammendments (1988)
CLRD – Chronic Liver or Renal Disease
CMC – Comprehensive Managed Care
CMCS – Center for Medicaid and CHIP Services
CMHC – Community Mental Health Center
CMIP – Comprehensive Medicaid Integrity Plan
CMP – Civil Money Penalty(s)
CMS – Centers for Medicare & Medicaid Services
CNA – Client Needs Assessment
CNM – Certified Nurse Midwife
CNOM – Costs Not Otherwise Matchable
CNS – Clinical Nurse Specialist
COBRA – Consolidated Omnibus Budget Reconciliation Act (1985)
CODEP – Coordination Only Dual Eligible Plans (MIPPA DSNP)
COI – Cost of Insurance
COPD – Chronic Obstructive Pulminary Disease
CORD – Childhood Obesity Research Demonstration
CORF – Comprehensive Outpatient Rehabilitation Facilities
CPAP – Continuous Positive Airway Pressure
CPE – Certified Public Expenditure
CPI – Center for Program Integrity
CPIU – Consumer Price Index for all Urban Consumers
CPNP – Certified Pediatric Nurse Practitioner
CPS – Current Population Survey
CPT – Current Procedural Terminology (American Medical Association)
CRA – Civil Rights Act (1964)
CRNA – Certified Registered Nurse Anesthetists
CRNP – Certified Registered Nurse Practioner
CSB – CIGNA Suplemental Benefits
CSG – (Kellog quote tool)
CSHCN – Children with Special Health Care Needs
CSNP Chronic Care Special Needs Plan
CSR – Cost Sharing Reductions
CSR – Corporate Social Responsibility
CT – Computerized Tomography
CTA – Computerized Tomography Angiography
CTM – Complaint Tracking Module (CMS)
CVAT – Cash Value Accumulation Test
CVD – Cardio Vascular Disorder
CY – Calendar Year

DE – Direct Enrollment pathway
DEFRA – Deficit Reduction Act
DFAS – Defense Financing & Accounting Service
DHRM – DSH Health Reform methodology
DM – Diabetes Mellitus
DME – Durable Medical Equipment
DMIs – Data Matching Issues
DNP – Doctor of Nursing Practice
DOI – Department of Insurance
DOJ – Department of Justice
DOL – Department of Labor
DRA – Deficit Reduction Act (2021)
DRG – Diagnosis Related Group
DSNP – Dual Eligible Special Needs Plan
DSRIP – Delivery System Reform Incentive Payment
DSRIP – Delivery System Reform Incentive Payment Performing Provider System
DUR – Drug Utilization Review
DxCG – Diagnostic Cost Group Risk Adjustment Model

EAC – Estimated Acquisition Cost
EAP – Enrollment Assistance Personnel assisters, employed by Cognosante for “Medicaid unwinding” in AZ, FL, IL, LA, MI, MT, NC, OK, SD, TN, TX & UT
EAPG – Enhanced Ambulatory Patient Group
EB-HRA – Excepted Benefit HRA
ECP – Essential Community Provider
ED – Emergency Department
EDC – External Distribution Channel
EDE – Enhanced Direct Enrollment pathway
EDI – Electronic Data Interchange
EDN – Eligibility Determination Notice
EFMAP – Enhanced Federal Medical Assistance Percentage
EFT – Electronic Funds Transfer
EGHP – Employer/Union Group Health Plan
EGWP – Employer Group Waiver Plans (Florida Blue)
EHB – Essential Health Benefits
EHR – Electronic Health Record
EKG – Electrocardiogram
ELE – Express Lane Eligibility
E/M – Evaluation and Management
EMTALA – Emergency Medical Treatment and Active Labor Act
E&O – Errors and Omissions
EOB – Explanation of Benefits
EOC – Evidence of Coverage
EOP – Explanation of Payments
EPO – Exclusive Provider Organization
EPSDT – Early and Periodic Screening, Diagnostics and Treatment
ERA – Electronic Remittance Advice (AKA EOB)
EQR – External Quality Review
EQRO – External Quality Review Organization
ERD – Expected Reinsurer Deficit
ERISA – Employee Retirement Income Security Act of 1974
ESC – Employer Sponsored Coverage
ESI – Employer Sponsored Insurance
ESRD – End Stage Renal Disease

FACI – Federal Advisory Committee on Insurance
FACI – Field Access to Customer Information
FAI – Financial Alignment Initiative
FATF – Financial Action Task Force
FBDE – Federal Benefit Dual Eligible
FBMI – Florida Blue Medicare Inc.
FCA – False Claims Act
FCC – Federal Communication Commission
FCHCO – Federal Coordinated Health Care Office
FCL – Florida Combined Life (Subidiary of Blue Cross)
FCPA – Foreign Corrupt Powers Act
FCRA – Fair Credit Reporting Act
FDA – Food and Drug Administration
FDR – First Tier, Downstream & Related Entity
FEP – Federal Employee Program
FERA – Fraud Enforcement Recovery Act
FinCEN – Financial Crimes Enforcement Network
FFCRA – Families First Coronavirus Response Act
FFL – Family First Life IMO
FFMs – Federally Facilitated Marketplaces, the Marketplace, “Health Insurance Marketplace”, “Exchange”
FFP – Federal Financial Participation
FFS – Fee For Service
FHCP – Florida Health Care Plans, Inc. (acquired by Florida Blue)
FIDE – Fully Integrated Dual Eligible Plans (DSNP)
FIDESNP – Fully Integrated Dual Eligible Special Needs Plan
FIFO – First In First Out
FISMA – CMS Federal Information Security Management Act
FMAP – Federal Medical Assistance Percentage
FMO – Field Marketing Organizations
FMR – Financial Management Report
FOA – Family Opportunity Act
Formulary – a list of medications available in a plan
FPG – Federal Poverty Guidelines
FPL – Federal Poverty Level
FQHC – Federally Qualified Health Center
FSA – Flexible Spending Account
FTC – Federal Trade Commission
FTE – Full Time Equivalent
FTI – Federal Tax Information
FTP – Failure To Pay
FTP – File Transfer Protocol
FUL – Federal Upper Limit
FY – Fiscal Year
FYC – First Year Commission
FYE – Full Year Equivalent

GA – General Agency
GA – General Agent
GAO – Government Accountability Office
GCIA – Grandchild Insurance Agreement
GDP – Gross Domestic Product
GIG Plans – Group Health Plans for Private Contractors
GINA – Genetic Information NonDiscrimination Act
GIO – Guaranteed Insurability Option
GIPO – Guaranteed Issuance Policy Option
GLIR – Guaranteed Lifetime Income Rider
GLP – Guideline Level Premium
GME – Graduate Medical Education
GMO – General Marketing Organization
GPP – Global Payment Program
GPT – Guideline Premium Test
GRIT – Great Rebound In the face of Tribulation
GSA – General Services Administration

HA – Health Assessment
HCAC – Health Care Acquired Condition
HCBS – Home and Community Based Service
HCC – Hierarchical Condition Category
HCERA – Health Care and Education Reconciliation Act
HCFA – Health Care Financing Administration
HCFAC – Health Care Fraud and Abuse Control Program
HCMS – Hierarchy and Compensation Management System
HCPCS – Health Care Common Procedure Coding System
HCRIS – Health Care Cost Reporting Information System
HCRP – High Cost Risk Pool
HCS – Hearing Care Solutions (CIGNA)
HCUP – Health Care Cost and Utilization Project
HEAT – Health Care Fraud Prevention and Enforcement Action Team
HEDIS – Health Care Effectiveness Data and Information Set
HHA – Home Health Aid
HHS – Department of Health and Human Services
HIPAA – Health Insurance Portability and Accountability Act (1996)
HICN – Health Insurance Claim Number
HICS – Hospital Incident Command System
HIDE – Highly Integrated Dual Eligible plans (DSNP)
HIDESNP – Highly Integrated Dual Eligible Special Needs Plan
HIE – Health Information Exchange
HIO – Health Insuring Organization
HIP – Health Insurance Plan
HIPAA – Health Insurance Portability and Accountability Act
HIT – Health Information Technology
HITECH – Health Information Technology for Economic & Clinical Health
HIU – Health Insurance Unit
HIV – Human Immunodeficiency Virus
HIX – Health Insurance Exchange
HMA – Health Matching Accounts
HMAS – Health Matching Account Services, Inc.
HMO – Health Maintenance Organization
HMOA – Health Maintenance Organization Act
HMRA – Health Matching Reimbursement Accounts
HMS – Home Mortgage Series
HNW – High Net Worth
HOPD – Hospital Outpatient Department
HPMS – Health Plan Management System
HPSA – Health Professional Shortage Area
HRA – Health Risk Assessment
HRAs – Health Reimbursement Arrangements
HRMS – Health Reform Monitoring Survey
HRR – Hospital Referral Region
HRSA – Health Resources and Services Administration
HSA – Health Savings Account
HSI – Health Services Initiative

I J K

IADL – Instrumental Activity of Daily Living
IBNRS – Incurred But Not Reported Survey
ICA – Independent Career Agent
ICA – (State) Information Counseling and Assistance
ICD – International Classification of Diseases
ICEP – Initial Coverage Election Period
ICF – Intermediate Care Facility
ICFID – Intermideiate Care Facility for those with Intellectual Disabilities
ICHRA – Individual Coverage HRA
ICL – Initial Coverage Limit
ICP – Individualized Care Plan
ICT – Interdisciplinary Care Team
ICU – Intensive Care Unit
IDD – Individuals with Intellectual Disabilities (Not IID)
IDR – Integrated Data Repository
IDV – Individual Dental & Vision
IEP – Initial Enrollment Period
IFP – Individual & Family Plan
IGT – Inter Governmental Transfer
IHS – Indian Health Service
IMD – Institutions for Mental Diseases
IME – Indirect Medical Education
IMMAA – Individual Medicare Marketing Authorization Addendum
IMO – Independent Marketing Organization
IMU – Index of Medical Underservice
INN – In Network
INN – International Nonproprietary Name
IOM – Institute of Medicine
IOP – Intensive Outpatient Program
IPA – Independent Provider Association
IPPS – Inpatient Prospective Payment System
IPUMS – Integrated Public Use Microdata Series
IRC – Internal Revenue Code
IRE – Independent Review Entity
IRMAA – Income Related Monthly Adjustment Amount
IRR – Internal Rate of Return
IRS – Internal Revenue Service
ISNP – Institutional Special Needs Plan
ISS – Information Security Services
IUL – Indexed Universal Life
IULE – Indexed Universal Life Express
IVR – Integrated Voice Recording
Joinder Agreement – an agreement to be added to an existing contract.
KYC – Know Your Customer

LADC – Licensed Alcohol and Drug Counselor
LEA – Local Education Agency
LEAN – Landmark Electronic Application Navigator
LEC – Limited Essential Coverage
LEP – Limited English Proficiency
LEP – Late Enrollment Penalty
LIFO – Last In First Out
LIHP – Low Income Health Program
LIS – Low Income Subsidy
LM – Licensed Midwife
LMO – Legally Mandated Organization
LMS – Learning Management System
LOA – Line of Authority
LOA – Licensed Only Agent
LOC – Level of Care
LPI – Low Performing Icon
LPLI – Limited Payment Life Insurance
LPR – Legal Permanent Resident
LPU – Life Paid Up
LTC – Long Term Care
LTSS – Long Term Services and Supports

MA – Medicare Advantage
MACBIS – Medicaid and CHIP Business Information Solutions
MACPAC – Medicaid and CHIP Payment and Access Commission
MACRA – Medicaid and CHIP Reauthorization Act
MAGI – Modified Adjusted Gross Income
MAP – Measure Applications Partnership
MAPD – Medicare Advantage Prescription Drug Plan
MAS – Maintenance Assistance Status
MAT – Medication Assisted Treatment
MAX – Medicaid Analytic Extract
MBES – Medicaid Budget and Expenditure System
MBI – Medicare Beneficiary Identifier
MBI – Medicaid Buy In
MCBS – Medicare Current Beneficiary Survey
MCCA – Medicare Catastrophic Coverage Act
MCE – Managed Care Entity
MCH – Maternal and Child Health
MCHD – MultiCultural Healthcare Distinction
MCHB – Maternal and Child Health Bureau
MCMG – Medicare Communication & Marketing Guidelines
MCO – Managed Care Organization
MCP – Medicare Cost Plan
M&E – Mortality & Expense
MEC – Minimum Essential Coverage Plans
MEC – Modified Endowment Contract
MED – Morphine Equivalent Dose
MEDIC – Medicare Integrity Contractor
MEDPAC – Medicare Payment Advisory Commission
MEMA – Member Enrollment Mix Adjustment
MEPS – Medical Expenditure Panel Survey
MEPSHC – Medical Expenditure Panel Survey – Household Component
MEPSIC – Medical Expenditure Panel Survey – Insurance Component
MEQS – Medicaid Eligibility Quality Control System
MFCU – Medicaid Fraud Control Unit
MFP – Money Follows the Person
MFSDB – Medicare Fee Schedule Data Base
MGA – Managing General Agency
MGA – Master General Agent
MH – Mental Health
MHPA – Mental Health Parity Act (1996)
MHPAEA – Mental Health Parity and Addiction Equity Act (2008)
MH/SUD – Mental Health/Substance Use Disorder
MIC – Medicaid Integrity Contractor
MIG – Medicaid Integrity Group
MII – Medicaid Integrity Institute
MIP – Medicaid Integrity Program
MIPPA – Medicare Improvement for Patients and Providers Act (CODEP)
MITA – Medicaid Information Technology Architecture
MLMS – Marketplace Learning Management System
MLR – Medical Loss Ratio (80% small group/ 85% large group)
MLTSS – Managed Long Term Services and Supports
MMA – Medicare Modernization Act
MMCDCS – Medicaid Managed Care Data Collection System
MMCO – Medicaid Medicare Coordination Office
MMDMP – Medicare Medicaid Data Match Program (Medi-Medi Program)
MMG – Medicare Marketing Guidelines
MMIS – Medicaid Management Information Systems
MMLR – Minimum Medical Loss Ratio
MMNA – Monthly Maintenance of Need Allowance
MMP – Medicare-Medicaid Plan
MMR – Marketing MisRepresentation
MMSEA – Medicair Medicaid and SCHIP Extension Act (2007)
MOC – Method of Care
MOE – Maintenance of Effort
MOEN – Marketplace Open Enrollment Notice
MOMS – Maternal Opiate Medicine Support Project
MOU – Memorandum of Understanding
MOUD – Medications to Treat Opioid Use Disorder
MPR – Minimum Participation Rate
MPRN – Minimum Participation Rate Navigator
MRA – Magnetic Resonance Angiogram
MRI – Magnetic Resonance Imaging
MRS – Magnetic Resonance Spectroscopy
MS – Multiple Sclerosis
MSA – Metropolital Statistical Area
MSB – Money Services Business
MSIS – Medicaid Statistical Information System
MSP – Managed Service Provider
MSP – Medicare Savings Program
MSTAT – Medicaid State Technical Assistance Team
MTM – Medication Therapy Management
MU – Medicaid Unwinding – (special qualifications from COVID 4/1-12/31/23).
MUA – Medically Underserved Area
MUP – Medically Underserved Population

NADAC – National Average Drug Acquisition Cost Survey
NAIC – National Association of Insurance Commissioners
NAMCS – National Ambulatory Medical Care Survey
NAMD – National Association of Medicaid Directors
NAR – Net Amount at Risk
NCANDS – National Child Abuse and Neglect Data System
NCCI – National Correct Coding Initiative
NCHS – National Center for Health Statistic
NCQA – National Committee for Quality Assurance
NDAA – National Defense Authorization Act
NDC – National Drug Code
NEADS – Now, Enjoy, Add/Altar, Decision, Summary anaylsis
NEDS – Nationwide Emergency Department Sample
NEHRS – National Electronic Health Records Survey
NEMT – Non-Emergency Medical Transportation
NEPQ – Neuro Emotional Persuasion Questioning
NF – Nursing Facility
NFLOC – Nursing Facility Level of Care
NHAMCS – National Hospital Ambulatory Care Survey
NHE – National Health Expenditures
NHIS – National Health Interview Survey
NHRA – Nursing Home Reform Act
NHSC – National Health Service Corps
NICU – Neonatal Intensive Care Unit
NIDA – National Institute on Drug Abuse
NIPR – National Insurance Producer Registry
NIPT – Non Institutional Provider Team
NIRT – National Institutional Reimbursement Team
NIS – Nationwide Inpatient Sample
NLC – Next Level Contracting
NMA – National Marketing Alliances
NMHSS – National Mental Health Services Survey
NMO – National Marketing Organization
NOPP – Notice of Privacy Practice
NPI – National Provider Identifier
NPN – National Producer Number
NPPES – National Plan and Provider Enumeration System
NPR – Net Patient Revenue
NPS – Net Promoter Score
NSCAW – National Survey of Child and Adolescent Well Being
NSHC – National Survey of Childrens’ Health
NSCSHCN – National Survey of Children with Special Health Care Needs
NSDUH – National Survey of Drug Use and Health
NSLP – National School Lunch Program
NSSATS – National Survey of Substance Abuse Treament Services

OACT – Office of the Actuary
OASI – Old Age and Survivors Trust Fund
OBA – Office of Benefits Administration
OBA – Officer’s Benefit Association
OBGYN – Obstetrician and Gyncologist
OBRA – Omnibus Budget Reconciliation Act (1990)
OCR – Office for Civil Rights
ODWCC – Outpatient Departmental Weight Cost to Charge
OE – Open Enrollment
OE – Operating Expenses
OEP – Open Enrollment Period
OEPI – Open Enrollment Period Institutional
OEV – Outbound Enrollment Verification
OFAC – Office of Foreign Assets Control
OFM – Office of Financial Management
OFR – Omnibus Final Rule (HHS)
OHI – Other Health Insurance
OIG – Office of the Inspector General
OMB – Office of Management and Budget
OON – Out of Network
OOP – Out of Pocket
OPD – Outpatient Department
OPFS – Outpatient Prospective Fee Schedule
OPM – Office of Personnel Management
OPPC – Other Provider Preventable Conditions
OPPS – Outpatient Prospective Payment System
OSB – Optional Supplemental Benefits
OT – Occupational Therapy
OTC – Over the Counter
OTP – Opioid Treatment Program
OTP – Over the Phone
OUD – Opioid Use Disorder

P4P – Pay For Performance
P&P – Privacy Policies & Procedures
PA – Physician Assistant
PA – Prior Authorization
PAC – Provider AssoCiate Level Variable ten digit code
PACE – Program of All Inclusive Care for the Elderly
PAHP – Prepaid Ambulatory Health Plans
PAPE – Payment Amount Per Episode
PBM – Pharmacy Benefit Manager
PBP – Plan Benefit Package
PBRHC – Provider Based Rural Health Clinic
PCA – Personal Care Attendant
PCC – Primary Care Clinician
PCCM – Primary Care Case Management
PCLs – Plan Category Limitations
PCMH – Patient Centered Medical Home
PCP – Preimary Care Provider
PCPCH – Patient Centered Primary Care Home
PCPCP – Primary Care Partial Capitation Provider
PCPM – Per Contract Per Month
PCRI – Primary Care Rate Increase
PDB – Producer Data Base
PDL – Preferred Drug List
PDM – Periodic Data Matching – Medicare
PDM – Death PDM; Medicaid PDM, CHIP PDM
PDMP – Prescription Drug Monitoring Program
PDP – Prescription Drug Plan
PDSS – Part D Senior Savings
PECL – Pre Enrollment Check List
PECOS – Provider, Enrollment, Chain & Ownership System
PEP – Politically Exposed Person
PERM – Payment Error Rate Measurement Program
PET – Positron Emission Tomography
PFFS – Private Fee For Service
PHCS – Private Health Care Systems
PHE – Public Health Emergency
PHI – Personal Health Information, also Protected Health Information
PHP – Prepaid Health Plan
PII – Personally Identifiable Information
PLMA – Producer Licensing Model Act
PMH – Pregnancy Medical Home
PMP – Primary Medical Provider
PMPM – Per Household Member Per Month
PMPY – Per Member Per Year
PNA – Personal Needs Allowance
PO – Privacy Officer
POA-HC – Power of Attorney for Health Care
POS – Point of Service
POS DIR – Point of Sale Direct
PPACA – Patient Protection Affordable Care Act
PPC – Provider Preventable Conditions
PPO – Preferred Provider Organization
PPS – Prospective Payment System
PQMP – Pediatric Quality Measures Program
PSM – Population Science Management
PT – Physical Therapy
PTC – Premium Tax Credit
PTC – Permission To Contact

Q R

QDWI – Qualified Disabled and Working Individual
QHP – Qualifying Health Plan
QI – Qualifying Individual
QIC – Qualified Independent Contractor
QIO – Quality Improvement Organizations
QLE – Qualifying Life Event
QMB – Qualified Medicare Beneficiary
QMB + – Qualified Medicare Beneficiary Plus Full Medicaid Benefits
QPP – Quality Payment Program
QRTP – Qualified Residential Treatment Program
QSEHRA – Qualified Small Employer Health Reimbursement Arrangement
RA (1973) – Rehabilitation Act
RAC – Recovery Audit Contract
RADV – Risk Adjustment Data Valuation
RATE – Remote Access Telephonic Enrollment
RBP – Reference Based Pricing Plans
RBRVS – Resource Based Relative Value Scale
RBRVU – Resource Based Relative Value Units
RCCO – Regional Care Collaborative Organizations
RCO – Regional Compliance Officer
RDU – Renal Dialysis Units
RFI – Request For Information
RFP – Request For Proposal
RHC – Rural Health Clinic
RICS – Reduction in Cost Share Allowance (CIGNA)
RMO – Regional Marketing Organization
RNFA – Registered Nurse First Assistants
RNHCI – Religious Non-Medical Health Care Institution
ROP – Return of Premium
ROY – Rest of Year
RRB – Railroad Retirement Board
RSSA – Registered Social Security Analyst
RTS – Ready to Sell
RVU – Relative Value Unit
RxDC – Prescription Drug Data Collection

SADP – Stand Alone Dental Plan
SAM – System for Award Management (General Services Administration)
SAMHSA – Substance Abuse and Mental Health Services Administration
SAR – Suspicious Activity Report
SB – Summary of Benefits
SBHC – School Based Health Center
SBHCTC – Small Business Health Care Tax Credit
SBIRT – Screening Brief Intervention and Referral to Treatment
SBC – Summary of Benefits and Coverage
SBMs – State Based Marketplaces
SBM-FPs – State-based Marketplaces on the Federal Platform
SBP – Survivor Benefit Plan
SC – Service Connected (VA)
SCI – Spinal Cord Injury
SDAP – Sales Development Action Program
SDMI – Severe Disabling Mental Illness
SDN – Specially Designated Nationals
SED – Severe or Serious Emotional Disturbance
SEDD – State Emergency Department Database
SEDS – Statistical Enrollment Data System
SEPs – Special Enrollment Periods
SFPFS – Senior Financial or Political Figures
SFY – State Fiscal Year
SGA – Substantial Gainful Activity
SGA – Supervising General Agency
SGRP – Social and Government Referral Program
SHADAC – State Health Access Data Assistance Center
SHIP – State Health Insurance Assitance Program
SHOP – Small Business Health Options Program
SIL – Special Income Level
SIM – State Information Models Program
SIPP – Survey of Income and Program Participation
SIU – Special Investigations Unit
SLCSP – Second Lowest Cost Silver Plan (Benchmark plan premium)
SLMB – Specified Low-Income Medicare Beneficiary
SLMB + – Specified Low-Income Medicare Beneficiary Plus Full Medicaid Benefits
SLP – Speech and Language Pathology
SMAC – State Maximum Allowable Cost
SMD – State Medicaid Doctor
SMI – Serious Mental Illness
SMMM – Severe Maternal Mortality and Morbidity
SNAP – Supplemental Nutrition and Assistance Programs
SNF – Skilled Nursing Facility
SNP – Special Needs Plan
SOA – Scope of Appointment
SOTA – State Operations and Technical Assistance Initiative
SOU – Statement of Understanding
SPA – State Plan Amendment
SPAP – State Pharmaceutical Assistance Program
Specialty Medication – high-cost complex drugs for chronic, rare or hard to treat conditions
SPMI – Serious Persistent Mental Illness
SPRY – State Plan Rate Year
SSA – Social Security Administration
SSBCI – Special Supplemental Benefits for the Chronically Ill
SSBG – Social Services Block Grant
SSC – Social Services Coordinator
SSDI – Social Security Disability Insurance
SSEPHI – Security Standards for Electronically Protected Health Information
SSI – Supplemental Security Income
ST – Speech Therapy
SUA – Specified Unlawful Activity
SUD – Substance Use Disorder
SUPPORT – Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act
SVIs – SEP Verification Issues

TAF – T-MSIS Analystic Files
TAMRA – Technical And Miscelaneous Revenue Act
TANF – Temporary Assistance for Needy Families
TAP – Technical Advisory Panel
TAT – Turn Around Time
TBI – Traumatic Brain Injury
TBI/SCI – Traumatic Brain or Spinal Cord Injury
TCPA – Telephone Consumer Protection Act
TEFRA – Tax Equity and Fiscal Responsibility Act
TEFT – Testing Experiences and Functional Tools Demonstration
TFL – Tricare for Life
TIA – Transient Ischemic Attack
TMA – Transitional Medical Assistance
TMSIS – Transformed Medicaid Statistical Information System
TNC – Transportation Network Companies
TPL – Third Party Liability
TPMO – Third Party Marketing Organization
TPO – Treatment, Payment, (healthcare) Operations
TRICARE – DOD (Dept. of Defense) healthcare program
TTWIIA – Ticket to Work and Work Incentives Improvement Act

UVWXYZ

U&C – Usual and Customary
UC – Uncompensated Care
UCC – Uncompensated Care Cost
UCR – Usual and Customary Rate
UDS – Uniform Data System
UHICA – United Healthcare Insurance Company of America
UPL – Upper Payment Limit
URA – Unit Rebate Amount
USC – Usual Source of Care
USDA – Uniform Simultaneous Death Act
USPSTF – U.S. Preventative Services Task Force
VA – Department of Veteran Affairs
VAIS – Value Added Items & Services
VBE – Value Based Enrollments
VBID – Value Based Insurance Design
VBP – Value Based Purchasing
VFC – Vaccines For Children Program
VHA – Veterans Health Administration (Army, Navy, Marines, Air Force, Coast Guard)
VLI – Variable Life Insurance
VMS – Vendor Management System (MSP Software)
VUL – Variable Universal Life
WAC – Wholesale Acquisition Cost
WCC – Weighted Cost to Charge
WDI – Working Disabled Individual
WIC – Special Supplemental Nutrition Program for Women Infants and Children
ZPIC – Zone Program Integrity Contractor