Care Management Application Glossary

A B C D E F G H I L M N O P R S T U V W X

2
• 278 X12 transaction
A
• ACA
• Accountable Care Organization (ACO)
• ACO
• active policy
• actual discharge date
• acute care
• adjudication
• admission date
• admission diagnosis
• admission source
• Affordable Care Act (ACA)
• affordable coverage
• alert
• alert category
• allowable charge
• appeal
• appeal reason
• approved length of stay
• assessment
• attending physician
• authentication
• authorization
• authorization appeal
• authorization request type
B
• barrier
• benefit
• benefit determination
• benefits package
• BMI
• Body Mass Index
• bundled payment
C
• capitation
• CARC
• care continuum
• care management
• Care Management Application
• care plan
• carve-out
• case management
• Center for Medicare and Medicaid Innovation (CMMI)
• charge amount
• Children's Health Insurance Program (CHIP)
• CHIP
• chronic
• claim
• Claim Adjustment Reason Code (CARC)
• claim attachment
• claim number
• claim status
• claims examiner
• CLIA
• clinical case type
• clinical decision support
• clinical review
• CMMI
• CMS
• COB
• COBRA
• code set type
• coinsurance
• complexity
• computerized patient record (CPR)
• computerized physician order entry (CPOE)
• concurrent review
• Consolidated Omnibus Budget Reconciliation Act (COBRA)
• contact channel
• contract
• copay
• copayment (copay)
• coverage
• coverage end date
• coverage limits
• coverage tier
• covered services
• CPOE
• CPR
• CPT
• credentialing
• Current Procedural Terminology
D
• date of service
• deductible
• denied authorization
• dependent
• designees
• diagnosis code
• diagnosis information
• diagnosis-related group
• Diagnosis-Related Groups
• disease management
• DME
• DRGs
• drug formulary
• duplicate coverage
• durable medical equipment (DME)
E
• EDI
• EDI translator
• edit
• EHR
• electronic data interchange (EDI)
• electronic health record (EHR)
• Electronic Medical Record
• electronic medical record (EMR)
• eligibility
• eligible
• emergency condition
• emergency room
• employer-sponsored coverage
• EMR
• encounter claim
• enrollee
• EOB
• episode
• e-prescribing
• explanation of benefits
F
• fulfillment
G
• global payments
• goal
• goal category
• group health coverage
H
• HCPCS
• health insurance exchange (HIX)
• Health Insurance Portability and Accountability Act (HIPAA)
• health maintenance organization (HMO)
• health plan
• Healthcare Common Procedure Coding System
• Healthcare Effectiveness Data and Information Set (HEDIS)
• healthcare provider
• HEDIS
• HIPAA
• HIX
• HMO
• home healthcare
• hospice care
I
• ICD-10
• ICD-9
• indemnity plan
• in-network
• inpatient
• inpatient care
• interaction
• interested parties
• International Classification of Diseases tenth revision (ICD-10)
• International Classification of Diseases tenth revision (ICD-9)
L
• level of care
• LOC
• lookup facility
M
• managed care
• MCG CareWebQI® Integration Solution
• McKesson InterQual Integration Solution
• Medicaid
• Medicaid reclamation claim
• Medical Loss Ratio (MLR)
• medical necessity
• Medicare
• member
• MLR
N
• National Committee for Quality Assurance (NCQA)
• National Provider Identifier
• NCQA
• network
• non-participating provider
• NPI
O
• OnDemand
• originator
• out of pocket
• out-of-network
• outpatient
• outpatient care
P
• paid amount
• participating provider
• patient
• patient 360
• patient ID
• Patient Protection and Affordable Care Act (PPACA)
• patient registry
• patient safety
• patient-centered medical home (PCMH)
• payer
• payment integrity
• PBM
• PCMH
• PCP
• peer-to-peer review
• pended claim
• personal health record (PHR)
• pharmacy benefit manager (PBM)
• PHR
• policy
• policy number
• policyholder
• population health
• POS plan
• post-adjudication
• PPACA
• PPO
• practitioner
• pre-adjudication
• pre-certification
• preferred provider organization (PPO)
• preventive services
• primary care
• primary care physician (PCP)
• prior authorization
• problem
• program
• program category
• provider
• provider network
R
• RARC
• referral
• referral reason
• referral services
• remittance advice remark codes (RARC)
• rendering physician
• requested units
• requesting provider
• restoration request
• retrieval request
• revenue code
• risk level
S
• scheduled admit date
• service provider
• service type
• skilled nursing care
• specialty
• subscriber
T
• task
• task category
• task ID
U
• urgency
• utilization management
• Utilization Management Review
V
• vital signs
W
• wellness program
• WHO
X
• X12 837