Structure and legal
| Acronym | Expansion |
|---|---|
| AKS | Anti-Kickback Statute |
| BAA | Business Associate Agreement |
| CPOD | Corporate Practice of Dentistry |
| CPOM | Corporate Practice of Medicine |
| CPVM | Corporate Practice of Veterinary Medicine |
| DSO | Dental Service Organization |
| FCA | False Claims Act |
| FMV | Fair Market Value |
| MSA | Management Services Agreement |
| MSO | Management Services Organization |
| PA | Professional Association |
| PC | Professional Corporation |
| PLLC | Professional Limited Liability Company |
| POPTS | Physician-Owned Physical Therapy Services |
| VIE | Variable Interest Entity |
Identifiers and enrollment
| Acronym | Expansion |
|---|---|
| CAQH | Council for Affordable Quality Healthcare |
| CVO | Credentialing Verification Organization |
| DEA | Drug Enforcement Administration (registration) |
| EIN | Employer Identification Number |
| LEIE | List of Excluded Individuals/Entities (OIG) |
| NPDB | National Practitioner Data Bank |
| NPI | National Provider Identifier |
| NPPES | National Plan and Provider Enumeration System |
| PECOS | Provider Enrollment, Chain, and Ownership System |
| PSV | Primary Source Verification |
| PTAN | Provider Transaction Access Number |
| TIN | Tax Identification Number |
Claims and EDI
| Acronym | Expansion |
|---|---|
| CARC | Claim Adjustment Reason Code |
| CDT | Current Dental Terminology |
| CPT | Current Procedural Terminology |
| EDI | Electronic Data Interchange |
| EFT | Electronic Funds Transfer |
| EOB | Explanation of Benefits |
| ERA | Electronic Remittance Advice |
| HCPCS | Healthcare Common Procedure Coding System |
| ICD-10-CM | International Classification of Diseases, 10th Revision, Clinical Modification |
| ICD-10-PCS | ICD-10 Procedure Coding System |
| NCCI | National Correct Coding Initiative |
| NDC | National Drug Code |
| NUBC | National Uniform Billing Committee |
| NUCC | National Uniform Claim Committee |
| PLB | Provider Level Adjustment |
| POS | Place of Service |
| RARC | Remittance Advice Remark Code |
| RVU | Relative Value Unit |
| TRN | Trace Number (reassociation) |
Group codes
| Code | Expansion |
|---|---|
| CO | Contractual Obligation |
| OA | Other Adjustment |
| PI | Payer Initiated Reduction |
| PR | Patient Responsibility |
Payers and programs
| Acronym | Expansion |
|---|---|
| ACA | Affordable Care Act |
| ACO | Accountable Care Organization |
| ASO | Administrative Services Only |
| BCBS | Blue Cross Blue Shield |
| CHIP | Children’s Health Insurance Program |
| CMS | Centers for Medicare & Medicaid Services |
| DSNP | Dual Eligible Special Needs Plan |
| EPO | Exclusive Provider Organization |
| FEHB | Federal Employees Health Benefits |
| FFS | Fee-For-Service |
| HMO | Health Maintenance Organization |
| IPA | Independent Practice Association |
| MA | Medicare Advantage |
| MAC | Medicare Administrative Contractor |
| MCO | Managed Care Organization |
| PBM | Pharmacy Benefit Manager |
| PIP | Personal Injury Protection |
| POS | Point of Service (plan type, distinct from Place of Service) |
| PPO | Preferred Provider Organization |
| TPA | Third-Party Administrator |
| VA CCN | VA Community Care Network |
Compliance and privacy
| Acronym | Expansion |
|---|---|
| ABN | Advance Beneficiary Notice |
| AI | Artificial Intelligence |
| CDS | Clinical Decision Support |
| CMP | Civil Monetary Penalty |
| DHS | Designated Health Services (Stark) |
| ePHI | Electronic Protected Health Information |
| HITECH | Health Information Technology for Economic and Clinical Health Act |
| MHPAEA | Mental Health Parity and Addiction Equity Act |
| NSA | No Surprises Act |
| OCR | Office for Civil Rights (HHS) |
| OIG | Office of Inspector General (HHS) |
| PHI | Protected Health Information |
| SRA | Security Risk Analysis |
| SUD | Substance Use Disorder |
| ZDR | Zero Data Retention |
Audits
| Acronym | Expansion |
|---|---|
| CERT | Comprehensive Error Rate Testing |
| MFCU | Medicaid Fraud Control Unit (state; investigates and prosecutes Medicaid fraud) |
| OMHA | Office of Medicare Hearings and Appeals (Medicare appeal level 3) |
| QIC | Qualified Independent Contractor (Medicare appeal level 2) |
| RAC | Recovery Audit Contractor |
| SIU | Special Investigations Unit |
| UPIC | Unified Program Integrity Contractor |
| ZPIC | Zone Program Integrity Contractor (legacy; largely succeeded by UPIC) |
Operations and finance
| Acronym | Expansion |
|---|---|
| AFR | Applicable Federal Rate |
| AR | Accounts Receivable |
| DACA | Deposit Account Control Agreement |
| EBITDA | Earnings Before Interest, Taxes, Depreciation, and Amortization |
| FTE | Full-Time Equivalent |
| GPCI | Geographic Practice Cost Index |
| KPI | Key Performance Indicator |
| KYB / KYC | Know Your Business / Know Your Customer |
| LLM | Large Language Model |
| MPPR | Multiple Procedure Payment Reduction |
| PEO | Professional Employer Organization |
| PFS | Physician Fee Schedule |
| QoE | Quality of Earnings |
| QSBS | Qualified Small Business Stock |
| RBRVS | Resource-Based Relative Value Scale |
| RCM | Revenue Cycle Management |
| VCC | Virtual Credit Card |
Clinical credentials
| Acronym | Expansion |
|---|---|
| APRN | Advanced Practice Registered Nurse |
| CPB | Certified Professional Biller |
| CPC | Certified Professional Coder |
| DDS / DMD | Doctor of Dental Surgery / Dental Medicine |
| DO | Doctor of Osteopathic Medicine |
| DPM | Doctor of Podiatric Medicine |
| DPT | Doctor of Physical Therapy |
| LCSW | Licensed Clinical Social Worker |
| LMFT | Licensed Marriage and Family Therapist |
| LPC / LMHC | Licensed Professional Counselor / Mental Health Counselor |
| MD | Doctor of Medicine |
| NP | Nurse Practitioner |
| OD | Doctor of Optometry |
| PA-C | Physician Assistant, Certified |
| PMHNP | Psychiatric-Mental Health Nurse Practitioner |
| PsyD | Doctor of Psychology |
Transactions
| Number | Meaning |
|---|---|
| 270 / 271 | Eligibility inquiry / response |
| 276 / 277 | Claim status inquiry / response |
| 277CA | Claim acknowledgment |
| 278 | Prior authorization request / response |
| 834 | Benefit enrollment |
| 835 | Remittance advice |
| 837P / I / D | Claim, professional / institutional / dental |
| 999 | Implementation acknowledgment |
| TA1 | Interchange acknowledgment |