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HIPAA

GLOSSARY

Acknowledgment - Notification sent from the receiver to the sender verifying the file was received and the status.  See Acknowledgements Document

Administrative Simplification  - A provision of HIPAA that 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.

American National Standards Institute - See ANSI

American Standards Committee X12 (ASC X12) - The committee chartered by the American National Standards Institute to develop uniform standards for inter-industry electronic interchange of data for business transactions.

ANS (American National Standards) - Standards developed and approved by organizations accredited by ANSI.

ANSI (American National Standards Institute) - A non-profit, privately funded organization that coordinates the development of voluntary national standards. The Institute, supported by many companies, as well as technical, trade, labor and consumer organizations and some government agencies encourages accredited organizations to develop standards and approves those developed under a consensus process as American National Standards.

ANSI Standard - Rules governing the structures of data in a message format for the exchange of business and operational information. Each ANSI standard is developed by an ASC X12 Committee and adopted by the full X12 committee through the consensus process of public announcement and review.

ASC (Accredited Standards Committee) - Organization that has been accredited by ANSI for the development of American National Standards (ANS).

Audit Trail - A permanent record of messages transmitted and received.

Batch Processing - A type of data processing operation and data communications transmission where related transactions are grouped together and transmitted for processing, usually by the same computer and under the same application; generally regarded as non-real-time data traffic consisting of large files.

Bookmark – A way to save shortcuts to your favorite web pages so you can navigate them easily.

Browser - Any client software that is used for looking at World Wide Web resources.

Business Associate – One who performs a function or activity on behalf of a covered entity. It excludes a person who is part of the covered entity's workforce.

Byte - A series of bits that represents a single character. Usually there are eight bits in a byte.

Case Sensitive - Distinguishing between uppercase and lowercase letters.

Claim Status - Health care providers may access on-line information on claims previously submitted to find payment information, status of checks to be issued, and claim denial information. The batch or real time request of claim status and return response is the 276/277 transaction.

Clearinghouse - A central agency for the collection and distribution of electronic transactions. A clearinghouse may or may not offer translation services of nonstandard transactions.

Code set - Under HIPAA, this is any set of codes used to encode data elements.

Communication Protocol – The communication protocol defines the rules for sending blocks of data from one node in a network to another node.

Communications Envelope - The catchall term for the electronic address, communications transport protocols and control information in a transaction. It is the electronic analogy of a paper envelope, i.e. a communications package.

Companion Document - Document containing instructions to clarify information in the ANSI Implementation Guides (TR3). The document should clarify but not contradict requirements in the TR3.

Conditional - A data element requirement designator, which indicates that the presence of a specified data element is dependent on the value or presence of other data elements in the segment.

Cookies - Information stored on a user's computer by a Web Browser at the request of software at a web site. Web sites use cookies to recognize users who have previously visited them. The next time the user accesses that site, the information in the cookie is sent back to the user so the information displayed can vary depending on the user's preferences.

Covered Entity - Means one of the following: A health plan; A health care clearinghouse; or a health care provider who transmits any health information in electronic form in connection with a transaction covered under HIPAA.

Data Compression - An automated process in which data is compressed and wrapped by removing trailing blanks and spaces from segments, groups and /or transactions. Data compression is useful in reducing resource usage, such as data storage space or transmission capacity.

Data Decompression - An automated process to decompress or "unwrap" data received by re-inserting trailing blanks and spaces.

Data Element - The smallest discreet item of information in an EDI transaction set. A data element may be single-character codes, literal descriptions, or numeric values.

Data Mapping - The association of data field contents from an internal computer system to the field contents in the EDI standard.  The same mapping takes place in reverse during the receipt of an EDI document.

Data Segment – An intermediate unit of information in a transaction set.  Each data segment has a unique two or three character identifier, a name, and a purpose.

Domain Name – Naming that uniquely identifies an Internet site. The domain name has two or more parts separated by dots. For example www.ask-edi.com or www.bcbsks.com

Download - To copy or move data from a main source to another source (such as your PC).

EDI (Electronic Data Interchange) – The computer-to-computer transmission of business data in a standard electronic format, therefore, replacing a traditional paper business document.

Edits - Global or payer specific business rules that transactions will run against and will reject if an error is detected.

EFT - (Electronic Funds Transfer) Credit or debit transactions sent within the Electronic Data Interchange.

EDI translation - The conversion of application data to and from an EDI standard format.

EDI translator - The computer software used to perform the conversion of application data to and from an EDI standard format.

EIN - Employer Identification Number. (see Tax ID)

Electronic Claim - Claims submitted by a provider or vendor via computer to computer transmission by a modem or internet connection. It is referred to in the industry as the ANSI 837 transaction.

Electronic Commerce - Business that is conducted over the internet.  Ecommerce can be between two businesses transmitting funds, goods, services and/or data between a business and a customer.

Electronic mailbox - The place where an EDI transmission is stored for pickup or delivery within a third party service provider's system. Trading partners can also maintain mailboxes within their own domain.

E-mail (Electronic mail) - Messages, usually text, sent from one person to another via computer. E-mail can also be sent to a large number of addresses automatically. This includes any communication service that permits the electronic transmission and storage of messages and attached files.

Encryption - The translation of data into a secret code. Encryption is the most effective way to achieve data security. To read an encrypted file you must have access to a key or password that enables you to decrypt it.

ERA (Electronic Remittance Advice) - Explanation of health care claim adjudication from a payer in the ANSI 835 transaction. Practice Management software may translate this transaction, and may allow for automatic posting of these transactions.

Errata – Errors in something published, or a list of errors and their corrections.

Firewall - A system designed to prevent unauthorized access to or from a private network. Firewalls can be implemented in both hardware and software, or combination of both.

FTP (File Transfer Protocol) - A standard way of transferring files from one computer to another on the Internet and other TCP/IP networks. FTP is also the name of any of various computer programs that implement the file transfer protocol.

Functional Group – A group of similar transaction sets that is bounded by a functional group header segment and a functional group trailer segment.

GUI (Graphical User Interface) – A human-computer interface that uses icons, menus and windows, and which can be manipulated by a mouse. This is usually pronounced "goo-ee".

Header - The portion of the message that precedes the actual body and trailer of the business transaction.

Health Care Claim Submission - Claims submitted electronically by institutional, professional and dental providers to payers in the ANSI 837 transaction for payment.

Health Care Eligibility Benefit and Inquiry Response - The access that healthcare providers have to on-line insured eligibility and benefit information to instantly verify eligibility at the time patients are seen by the provider. The batch or real time request of claim status and return response is the 270/271 transaction.

Health Care Request for Review and Response - Request for claim review, known in the industry as the ANSI 278 transaction.

HIPAA (The Health Insurance Portability and Accountability Act) - It mandates 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.

Home Page – The main, web page for an Internet website.

HTML (HyperText Markup Language) - The authoring language used to create web pages.

HTTP (Hypertext Transfer Protocol) – This is an application level protocol for distributed, collaborative, hypermedia information systems.  HTTP is the foundation of data communication for the World Wide Web.

HTTPS (also called HTTP over TLS, HTTP over SSL, and HTTP Secure) – The protocol for secure communication over a computer network which is widely used on the Internet.

Implementation Guide (IG) - A document explaining the proper use of a standard for a specific business purpose. The X12N HIPAA IGs are the primary reference documents used by those implementing the associated transactions, and are incorporated into the HIPAA regulations by reference. See also TR3(Technical Report Type 3)

IP Address (Internet Protocol Address) - The numeric address of a computer that is in the format used on the Internet.

Interactive Web Site - A method where information entered on a Web site is passed to other systems for processing to store, confirm, or respond to an inquiry.

Interchange – Typically this term connotes the ISA/IEA envelope that is transmitted between trading partners.

Internet – The global system of interconnected computer networks that use the Internet Protocol Suite (TCP/IP) to link billions of devices worldwide.

Internet Service Provider (ISP) – This is an organization that provides services for accessing, using, or participating in the Internet.

Intranet - A secure, private network, accessible only to an organization's staff. An Intranet uses the same type of protocols (TCP/IP) and software found on the public Intranet.

LAN (Local Area Network) - A computer network that interconnects computers within a limited area such as a residence, school, laboratory or office building. LANs can be linked together in larger networks called Wide Area Networks (WANs).

Link – A reference in an electronic document that lets a user display or activate another document or program.   Also known as hyperlink.

List Server – This is a program that handles subscription requests for a mailing list and distributes new messages, newsletters, or other postings.

Logical File - In ANSI, a logical file is each ISA-IEA segment within a physical file.

Loop - A series of instructions that is repeated until a certain condition is met. Each pass through the loop is called a iteration.

Mainframe Processor – Computers used primarily by large organizations for critical applications, bulk data processing, enterprise resource planning and transaction processing.

National Provider ID (NPI) - A system for uniquely identifying all providers of health care services, supplies, and equipment.

NCPDP (National Council for Prescription Drug Programs) - An ANSI-accredited group that maintains a number of standard formats for use by the retail pharmacy industry, some of which are included in the HIPAA mandates.

Network - The connecting of two or more computers to share resources forms a network.

Network Service Vendor - An agent that offers telecommunication connectivity solutions.

Payer - An entity that assumes the risk of paying for medical treatments. This can be an uninsured patient, a self-insured employer, or a health care plan or health maintenance organization (HMO).

Payer ID Number – A unique number that is assigned to an insurance company for the purpose of electronically routing claims.

Performing Provider Number - See Rendering Provider Number.

Physical File – This is the entire file that is transmitted or received. Physical files may contain one or many logical files.

Port - An interface on a computer to which you can connect a device.

Print Image File - A file created by a software system that is in the format of the CMS1500 or UB04.

Proprietary format - A data format specific to a company, industry or other limited group. Proprietary formats do not comply with EDI standards.

Provider - The entity that provides services to the insured.

Provider Taxonomy Code - See Taxonomy Code.

Real-Time Transactions – The processing of transactions the instant each is received by, or entered into, a computer system.

Receiver - The location where claims are transmitted or submitted. This can be a clearinghouse or payer.

Rejected Claims - Electronic claims that did not pass the EDI system edits. Rejected claims will not be forwarded to the payer, but should be corrected and resubmitted.

Response Reports - Status of transactions sent to the EDI system.  See Acknowledgement Manual for specific reports.

Router – Small electronic devices that join multiple computer networks together via either wired or wireless connections.

Search Engine – A software system that is designed to search for information on the web.  The search results are generally presented in a line of results.  The information may be a mix of web pages, images, and other types of files.

Secondary Payer – This is the plan, insurance policy or program that adjudicates second on a claim for medical care.

Security –The protection of information systems from theft or damage to the hardware, the software, and to the information on them, as well as from disruption or misdirection of the services they provide.

SSL Protocol (Secure Socket Layer) – A secure channel between two machines operating over the Internet or an internal network.

Submitter ID Number - See Trading Partner Number.

Syntax - The grammar or rules which define the structure of EDI standards.

Tax ID Number – An identification number used by the Internal Revenue Service (IRS) in the administration of tax laws. This is also known as the EIN (Employer Identification Number).

Taxonomy Code - An administrative code set for identifying the provider type and area of specialization for all health care providers. A given provider can have several Provider Taxonomy Codes. This code set is used in the X12-278 Referral Certification and Authorization and the X12 837 Claim transactions, and is maintained by the NUCC (National Uniform Claim Committee)
Taxonomy Codes can be found at http://www.wpc-edi.com/codes/Codes.asp

TCP/IP (Transmission Control Protocol/Internet Protocol) - The suite of communications protocols used to connect hosts on the Internet. TCP/IP software is now available for every major kind of computer operating system.

Tertiary Payer – This is the plan, insurance policy or program that adjudicates third on a claim for medical care.

TLS Protocol (Transport Layer Protocol) – A protocol that allows client-server applications to communicate across a network in a way designed to prevent eavesdropping and tampering.

TR3(Technical Report Type 3) - See Implementation Guide

Trading Partner –One of the two or more participants who have agreed to exchange electronic business data.

Trading Partner Number - A unique number assigned by ASK to identify the entity sending or receiving electronic transactions.

Trailer record – A record which contains data pertaining to an associated group of records that is immediately preceding it.

Transaction Set –The smallest meaningful set of information exchanged between trading partners.  The transaction set consists of a transaction set header segment, one or more data segments in a specified order, and a transaction set trailer segment.

Translator - A software tool with the ability to accept an EDI transmission and convert the data into another format.

Transmission - Data that is electronically sent between computer systems.

Upload - To send data to a remote system such as a server or another client so that remote system can store a copy.

URL (Uniform Resource Locator) – A unique reference to a resource that is accessible on  the Internet.

VPN (Virtual Private Network) - These systems use encryption and other security mechanisms to insure that only authorized users can access the network and the data cannot be intercepted.

WAN (Wide Area Network) - A large network, usually consisting of a collection of LANs,  that spans a large geographical area.

Washington Publishing Company (WPC) - A company that publishes the X12N HIPAA Implementation Guides and developed and published the X12N HIPAA Data Dictionary.  http://www.wpc-edi.com/

Web Site – A set of related web pages typically served from a single web domain. The pages of a website can usually be accessed from a simple Uniform Resource Locator (URL) called the web address.

Wi-fi -  A local area wireless computer networking technology that allows electronic devices to connect to the network.

WWW (World Wide Web) – An open source information space where documents and other web resources are identified by URLs, interlinked by hypertext links, and can be accessed via the Internet.

XML (Extensible Markup Language) – This is a markup language that defines a set of rules, for encoding documents in a format which is both human-readable and machine-readable.

X12 - An ANSI-accredited group that defines EDI standards for many American industries, including health care insurance. Most of the electronic transactions standards mandated or proposed under HIPAA are X12 standards.

 

ASK WEB GLOSSARY
02/2016