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State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesGLOSSARY OF ACRONYMSAcronymDescription508Section 508 of the Rehabilitation Act requires that institutions receiving federal funds solicit,procure, maintain and use all electronic and information technology (EIT) so that equal oralternate/comparable access is given to federal employees and members of the public with andwithout disabilities.4010 FormatPre 1/1/12 version of the HIPAA electronic transaction standardsTax-exempt charitable organizations and quirementsSection-501(c)(3)-OrganizationsIs the new version of the 4010 Format, and required to be in use by January 1, 2012.5010 rsion-5010-electronic.page?A/I/U“Adopt, Implement or Upgrade”. Defined in CMS regulations at 42 CFR 495.302 as (1) Acquire,purchase, or secure access to certified EHR technology; (2) Install or commence utilization ofcertified EHR technology capable of meeting meaningful use requirements; or (3) Expand theavailable functionality of certified EHR technology capable of meeting meaningful userequirements at the practice site, including staffing, maintenance, and training, or upgrade fromexisting EHR technology to certified EHR technology per the ONC EHR certification criteria.ABDAged, Blind and DisabledACAPatient Protection and Affordable Care ActACSAffiliated Computer Systems – Vendor providing the Medicaid Management Information System(MMIS) to provide core administrative capabilities for DOM; Otherwise known as XeroxADAAmerican Dental Association; The ADA is the professional association of dentists that maintainsthe Current Dental Terminology (CDT) for dental procedure codes and the paper dental billingform, currently the 2006 ADA Dental Claim Form.ADURSAmerican Drug Utilization Review SocietyAFDCAid to Families with Dependent Children. This Federal program was replaced by TemporaryAssistance for Needy Families (TANF) in 1997.AHFSAmerican Hospital Formulary ServicesALGAutomatic Letter GenerationANSIAmerican National Standards Institute. An accepted standards-setting body for the computerindustry.Appendix Q: Glossary of AcronymsPage 1
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesANSIAmerican National Standards Institute. An accepted standards-setting body for the computerindustry.APCsAmbulatory Payment ClassificationsAPDAdvance Planning Document. A federally required document that is used by States to informCMS of their intentions related to federally funded programs, and request approval and funding toaccomplish their needs and objectives. The term APD could refer to a Planning APD (PAPD),Implementation APD (IAPD), or an Advance Planning Document Update (APDU).APIApplication Programming Interface. An interface used within the application to communicatebetween components and modules or with external systems.APR-DRGAll Patient Refined Diagnosis Related Groups. Expands the basic DRG structure and iscomprised of a clinical model and four severity of illness and risk of mortality subclasses for eachbase APR DRG. Taken together, the APR-DRG and the severity of illness further refine CMSDRGs to provide more precise classification of patients.ARRAAmerican Recovery and Reinvestment ActASAAverage Speed of Answer. The average amount of time a caller will wait in queue for an agent tobecome available. This unit of measure is influenced by the average length of each call, thenumber of agents, and the total number of calls arriving.ASC X12Accredited Standards Committee X12. ASC X12 develops, maintains, interprets, publishes, andpromotes the proper use of American National Standards and UN/EDIFACT internationalstandards for electronic data interchange (EDI).ATPAutomated Test PanelAVRAutomated voice responseAVRSAutomated Voice Response SystemAWPAverage Wholesale PriceB2IBridge to IndependenceBAABusiness Associate AgreementBAFOBest and Final OfferBCCTPBreast and Cervical Cancer Treatment and screening programsBC-DRBusiness Continuity and Disaster RecoveryBCPBusiness Continuity Plan. A plan for continuation of operations in the event of an emergency.BENDEXBeneficiary & Earnings Data Exchange. A file containing data from the Federal Governmnetregarding all persons receiving benefits from SSA and the Veterans Administration.Appendix Q: Glossary of AcronymsPage 2
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesBIBusiness IntelligenceBIPBroadband Initiatives ProgramBMIBody Mass IndexBPELBusiness Process Execution LanguageBPMBusiness Process ManagementBREBusiness Rules EngineBTOPBroadband Technology Opportunities ProgramCAATTComputer Assisted Audit ToolsCAHCritical Access HospitalCAPCorrective Action PlanCASClaim Adjustment. A segment in the X12 835.CBTComputer Based trainingCCCall CenterCCDContinuity of Care Document – XML-based document containing the encoding, structure, andsemantics of a patient’s clinical summary document for exchangeCCHITCertification Commission for Healthcare Information TechnologyCCICorrect Coding InitiativeCCIIOCenter for Customer Information and Insurance OversightCCNCMS Certification NumberCCOCoordinated Care OrganizationsCDCompact DiskCDAClinical Document ArchitectureCDCCenters for Disease Control and Prevention - http://www.cdc.gov/CD-ROMCompact Disk – Read Only MemoryCDTCurrent Dental TerminologyCFHCCoastal Family Health CenterAppendix Q: Glossary of AcronymsPage 3
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesCFRCode of Federal Regulations. A codification of the general and permanent rules published in theFederal Register by the Executive departments and agencies of the Federal Government. TheseFederal rules direct a State in its administration of a Medicaid Program and implementation andoperation of an MMIS.CHAMPUSCivilian Health and Medical Program of the Uniformed ServicesCHIPChildren’s Health Insurance Program - http://www.cms.gov/home/chip.aspCHIPRAChildren’s Health Insurance Program Reauthorization ActCHIRPAComprehensive Health Insurance Risk Pool Association - http://www.mississippihealthpool.org/CICSCustomer Information Control System. Communication manager software used for on-lineapplications in an IBM mainframe environment.CLIAClinical Laboratory Improvement AmendmentsCMCase ManagementCMMICapability Maturity Model Integration. CMMI is a process improvement approach that providesorganizations with the essential elements of effective processes that ultimately improve theirperformance. CMMI can be used to guide process improvement across a project, a division, or anentire organization.CMPConfiguration Management Plan. A plan related to the field of management that focuses onestablishing and maintaining consistency of a system's or product's performance and its functionaland physical attributes with its requirements, design, and operational information throughout itslife.CMSCenters for Medicare and Medicaid Services (formerly HCFA). This is the Federal agencyresponsible for the administration of the Medicaid, Medicare, and other health care programs.http://www.cms.gov/COBCoordination of BenefitsCOBCCoordination of Benefits Contractor. A single contractor entity, established by CMS, to performall activities that support the collection, management, and reporting of other insurance coverageof Medicare beneficiaries. Sends Medicare crossover claims to DOM.COBRAConsolidated Omnibus Budget Reconciliation Act of 1985, which required State Medicaidprograms to cover persons that meet certain eligibility requirements.COECategory of eligibility (for beneficiaries)COLACost-of-Living Adjustment. A COLA is an automatic adjustment in benefits that occurs annually.The purpose of the COLA is to ensure that the purchasing power of Social Security andSupplemental Security Income (SSI) benefits is not eroded by inflation.CONNECTCreating Online NICU Networks to Educate, Consult and Team; A project to expand upon anelectronic medical records-sharing initiative for high-risk infants; use telemedicine technologiesto enhance evidence and create Web-based decision support resources for physicians who care forAppendix Q: Glossary of AcronymsPage 4
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent Servicesinfants.CORBACommon Object Request Broker ArchitectureCOSCategory of Service. A classification of medical services authorized under Medicaid (e.g.,physician, inpatient hospital, ICF, etc.)COTSCommercial-off-the-Shelf. An adjective that describes software or hardware products that areready-made and available for sale to the general public. For example, Microsoft Office is a COTSproduct that is a packaged software solution for businesses. COTS products are designed to beimplemented easily into existing systems without the need for customization.CPOEComputerized Physician Order EntryCPTCommon Procedural Terminology. A unique coding structure scheme for all medical proceduresapproved by the American Medical Association. The CPT code set accurately describes medical,surgical, and diagnostic services and is designed to communicate uniform information aboutmedical services and procedures among physicians, coders, patients, accreditation organizations,and payers for administrative, financial, and analytical purposes. The current version is the CPT2009.CQMClinical Quality MeasuresCRHCenter for Rural HealthCRMCustomer Relations Management SystemCSRComputer Systems Request or Customer Service Request. The Change Management namingconvention for all changes in the new MS Medicaid Enterprise.CTTCase tracking toolCWFCommon Working File. The CWF is a single data source for Fiscal Intermediaries and Carriers toverify beneficiary eligibility and conduct prepayment review and approval of claims from anational perspective. It is the only place in the fee for service (FFS) claims processing systemwhere full individual beneficiary information is housed.CWSChild Welfare Services. Program for foster children under age 21 who are in the custody of theDepartment of Human Services and for children receiving State Subsidized Adoption paymentsfrom the Department of Human Services.DACDisabled Adult ChildDBDatabase. A collection of information organized in such a way that a computer program canquickly select desired pieces of data. You can think of a database as an electronic filing system.DBADatabase AdministratorDBMSDatabase Management System. An integrated (object-oriented or relational) comprehensivedatabase management system, including all data and all internal and linked databases.DDEDirect Data EntryAppendix Q: Glossary of AcronymsPage 5
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesDDIDesign, Development, and ImplementationDEADrug Enforcement AdministrationDEDData Element DictionaryDEERDefense Enrollment Eligibility reportingDESIDrug Efficacy Study ImplementationDHADelta Health AllianceDHHSUnited States Department of Health and Human ServicesDHSDepartment of Human ServicesDICOMDigital Imaging and Communications in MedicineDMEDurable Medical Equipment. A category of service involving medical equipment and supplies forhome or institutional use.DMHMississippi Department of Mental Health - http://www.dmh.state.ms.us/DOCDepartment of CommerceDoDDepartment of Defense - http://www.defense.gov/DOMDivision of Medicaid. The State agency in Mississippi which administers the Medicaid programunder statutory provisions, administrative rules, and the State’s Medicaid Plan, in conformity withFederal law and CMS policy. http://www.medicaid.ms.gov/DOPDate of PaymentDPDesktop PublishingDRAMSDrug Rebate Analysis/Management SystemDRGDiagnosis-Related Group. A prospective inpatient hospital reimbursement methodology used inMedicare. Under DRG, a single flat amount is paid per discharge.DRPDisaster Recovery PlanDesignated Record Set. The HIPAA Privacy Rule establishes the right of individuals to inspect,obtain a copy of, and request amendments to information about them in a designated record set. Adesignated record set is defined as a group of records maintained by or for a covered entity that is:DRSThe medical and billing records about individuals maintained by or for a coveredhealthcare providerThe enrollment, payment, claims adjudication, and case or medical management recordsystems maintained by or for a health planAppendix Q: Glossary of AcronymsPage 6
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesDSDDetailed System DesignDSLDigital Subscriber Line. A family of technologies that provides digital data transmission over thewires of a local telephone network.DSMODesignated Standards Maintenance OrganizationDSSDecision Support SystemDSS/DWDecision Support System and Data WarehouseDURDrug Utilization Review. A therapeutic drug utilization review program designed to identifybeneficiaries at high risk for drug induced illness, communicate these risk factors to physiciansand pharmacies, and modify drug therapies to reduce or eliminate these risks.DWData Warehouse. A collection of data designed to support management decision making. Datawarehouses contain a wide variety of data that present a coherent picture of business conditions ata single point in time.EAEnterprise ArchitectureEACEstimated Acquisition Cost (for drugs)EAIEnterprise Application Integration. EAI is the unrestricted sharing of data and business processesthroughout the networked applications or data sources in an organization.EDBEnrollment Data Base (Medicare)EDIElectronic Data Interchange – The electronic transmission of structured data fecs.com/EDMSElectronic Document Management SystemEDPElectronic Data ProcessingEFTElectronic Funds TransferEHEligible HospitalEHNACAccreditedElectronic Healthcare Network Accreditation Commission - http://www.ehnac.org/EHRElectronic Health Record. An electronic record of health-related information on an individual thatconforms to nationally recognized interoperability standards and that can be created, managed,and consulted by authorized clinicians and staff across more than one health care organization.ELCEnterprise Life CycleAppendix Q: Glossary of AcronymsPage 7
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesEMCElectronic Media Claims (tape, disk, and telecommunications)eMPIEnterprise Master Patient Index – Master Patient Indexes link smaller organizational level MPIstogether to identify, match, merge, de-duplicate, and clean patient records to create a clear viewof a patient’s medical recordEMRElectronic Medical Record. An electronic record of health-related information on an individualthat can be created, gathered, managed, and consulted by authorized clinicians and staff withinone health care organization.EOBExplanation of BenefitsEOMBExplanation of Medical Benefits. A notice issued to Medicaid beneficiaries that explains thepayment of services made on their behalf and requests verification that the service was actuallyreceived.EPEligible Provider including eligible professionals and eligible 30 Meaningful Use.aspePHIelectronic Protected Health InformationEPSDTEarly and Periodic Screening, Diagnosis, and Treatment (for children under 21 years of age)ESBEnterprise Service Bus. (Also referred to as a message broker.) ESB is an open standards-baseddistributed synchronous or asynchronous messaging middleware that provides secureinteroperability between enterprise applications via XML, Web services interfaces andstandardized rules-based routing of documents.ESCElectronic Submission of Claims. The transmitting of Medicaid claims electronically to the FiscalAgent.ESRDEnd Stage Renal DiseaseETLExtract Transform Load. Three database functions that are combined into one tool to pull data outof one database and place it into another database. ETL is used to migrate data from one databaseto another, to form data marts and data warehouses and also to convert databases from one formator type to another.EVSEligibility verification requestF&AFraud and AbuseFAFiscal Agent. An organization under contract to perform functions, such as claim processing, forthe Medicaid Program.FADFraud and Abuse DetectionFADSFraud and Abuse Detection SystemFAQ / FAQsFrequently Asked Questions. Pronounced as separate letters. A document that poses a series ofcommon questions and answers on a specific topic.Appendix Q: Glossary of AcronymsPage 8
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesFBFaxback capabilitiesFBRFederal Benefit Rate. Used in Mississippi to calculate the maximum SDX payment to abeneficiary.FCCFederal Communications CommissionFDAFood & Drug Administration. Publish the NDC codes.FDBFirst DataBank. The vendor that provides the commonly used drug file with updated pricing andclinical information which Medicaid systems use to support pharmacy POS processing, DUR andreporting.FEINFederal Employer Identification NumberFFEFederally Facilitated ExchangeFFPFederal Financial Participation. A percentage of State expenditures to be reimbursed by theFederal Government for medical assistance and for the administrative costs of the Medicaidprogram.FFSFee-for-ServiceFHAFederal Health Architecture, an E-Government Line of Business initiative managed by the Officeof the National Coordinator for Health IT. FHA was formed to coordinate health IT activitiesamong the more than 20 Federal Agencies that provide health and healthcare services to citizensFICAFederal Insurance Contributions Act. A United States payroll (or employment) tax imposed bythe Federal government on both employees and employers.FIPSFederal Information Processing StandardFMACFederal Maximum Allowable Cost. The maximum amount the CMS will allow for a specificdrug; acts as an upper ceiling on State drug reimbursement, but does not apply to all drugs. Seealso MAC.FMAPFederal Medical Assistance PercentageFPLFederal Poverty Level. The minimum income required to support basic living costs for a family.The FPL is established yearly by the Federal Government and is based on the number of personsin a family.FPWFamily Planning WaiverFQHCFederally Qualified Health Center. FQHCs are ‘safety net’ providers, such as community healthcenters, public housing centers, outpatient health programs funded by Indian Health Services, andprograms serving migrants and the homeless.FTEFull-Time EquivalentFTPFile Transfer ProtocolAppendix Q: Glossary of AcronymsPage 9
State of Mississippi, Division of MedicaidRequest for Proposals #20131025MS MES and Fiscal Agent ServicesFULFederal Upper LimitFYFiscal Year. Federal: October 1 through September 30; Mississippi: July 1 through June 30.GAAPGenerally Accepted Accounting PrinciplesGAASGenerally Accepted Auditing Standards. Ten sets of standards, developed by the AmericanInstitute of Certified Public Accountants, consisting of general standards, standards of field work,and standards of reporting (along with interpretations), against which the quality of audits areperformed and may be judged.Generally Accepted Government Auditing Standards. Auditing standards, commonly referred toas the "Yellow Book", produced in the United States by the Government Accountability Office(GAO). The standards apply to both financial and performance audits of government agencies.Five general standards are included:GAGASIndependenceDue CareContinuing Professional Education (CPE)Superv
GLOSSARY OF ACRONYMS Acronym Description 508 Section 508 of the Rehabilitation Act requires that institutions receiving federal funds solicit, procure, maintain and use all electronic and information technology (EIT) so that equal or alternate/comparable access is give
