ACH Automated Clearing House

AMA American Medical Association

ARU Automated Response Unit

BPI Bytes Per Inch

CCD+ Cash Concentration/Disbursement Plus

CIA Coverage Issues Addendum

CIM Coverage Issues Manual

DHHS Department of Health and Human Services

DME Durable Medical Equipment

DMEPOS Durable Medical Equipment Prosthetics, Orthotics and Supplies

DMERC Durable Medical Equipment Regional Carrier

EFT Electronic Funds Transfer

EIN Employer Identification Number

EMC Electronic Media Claim

ERN Electronic Remittance Notice

HCFA Health Care Financing Administration

HCPCS HCFA Common Procedure Coding System

HI Hospital Insurance Program (Part A)

HICN Health Insurance Claim Number

ICC Individual Claim Consideration

MSP Medicare Secondary Payor

NACHA National Automated Clearing House Association

NOC Not Otherwise Classified

NSC National Supplier Clearinghouse

NSF National Standard Format

OCHAMPUS Office of Civilian Health & Medical Program of the Uniformed Services

OCNA Other Carrier Name Address

SADMERC Statistical Analysis DMERC

SMI Supplementary Medical Insurance Program (Part B)

SSN Social Security Number

Assignment In the Original Medicare Plan, this means a doctor or supplier agrees to accept the Medicare-approved amount as full payment. If you are in the Original Medicare Plan, it can save you money if your doctor accepts assignment. You still pay your share of the cost of the doctor's visit.

Beneficiary The name for a person who has health care insurance through the Medicare or Medicaid program.

HIPAA Health Insurance Portablilty & Accountability Act of 1966 Federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. Title II, Subtitle F, of HIPAA gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information. Also known as the Kennedy-Kassebaum Bill, the Kassebaum-Kennedy Bill, K2, or Public Law 104-191.

Deductible The amount you must pay for health care or prescriptions, before Original Medicare, your prescription drug plan, or other insurance begins to pay. For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.

Coinsurance The amount you may be required to pay for services after you pay any plan deductibles. In the Original Medicare Plan, this is a percentage (like 20%) of the Medicare approved amount. You have to pay this amount after you pay the deductible for Part A and/or Part B. In a Medicare Prescription Drug Plan, the coinsurance will vary depending on how much you have spent.

Co-Payment In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a doctor’s visit, or prescription. A copayment is usually a set amount you pay. For example, this could be $10 or $20 for a doctor’s visit or prescription. Copayments are also used for some hospital outpatient services in the Original Medicare Plan

Coorindation of Benefits Process for determining the respective responsibilities of two or more health plans that have some financial responsibility for a medical claim. Also called cross-over.