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Glossary

Acknowledgment
Notification sent from the receiver to the sender verifying the file was received and the status; i.e. 277CA, 999, TA1.  See Acknowledgements Document.
American Standards Committee X12 (ASC X12)
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)
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).
Batch Processing
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.
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.
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
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.
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
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.
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
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
Automated process to decompress or "unwrap" data received by re-inserting trailing blanks and spaces.
Data Element
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
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
Intermediate unit of information in a transaction set.  Each data segment has a unique two or three-character identifier, a name, and a purpose.
EDI (Electronic Data Interchange)
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
Conversion of application data to and from an EDI standard format.
EDI translator
Computer software used to perform the conversion of application data to and from an EDI standard format.
EIN
Employer Identification Number. See Tax ID Number.
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 mailbox
Place where an EDI transmission is stored for pickup or delivery Also referred to as Home Folder.
Encryption
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
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.
Functional Group
Group of similar transaction sets that is bounded by a functional group header segment and a functional group trailer segment.
GUI (Graphical User Interface)
Human-computer interface that uses icons, menus and windows, and which can be manipulated by a mouse. This is usually pronounced "gooey."
Header
Portion of the message that precedes the actual body and trailer of the business transaction.
Health Care Benefit Enrollment and Maintenance (membership files)
Transaction 834. An electronic version of a paper Benefit Enrollment and Maintenance.
Health Care Claim Submission
Claims submitted electronically by institutional, professional and dental providers to payers in the ANSI 837 transaction for payment; i.e. 837P, 837I, 837D.
Health Care Claim Status Request and Response
Transaction 276/277. Used by healthcare providers to verify the status of a claim submitted previously to a payer.
Health Care Eligibility Benefit and Inquiry Response
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)
HIPAA 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 Folder
Place where an EDI file transmission is uploaded and stored for delivery to ASK. The home folder will be identified as /Home/EDI/Your Trading Partner #/ on the ASK site.
HTTPS (also called HTTP over TLS, HTTP over SSL, and HTTP Secure)
Protocol for secure communication over a computer network which is widely used on the Internet. See also SFTP.
Implementation Guide (IG)
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).
Interchange
Typically this term connotes the ISA/IEA envelope that is transmitted between trading partners.
List Server
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
Series of instructions that is repeated until a certain condition is met. Each pass through the loop is called an iteration.
Mainframe Processor
Computers used primarily by large organizations for critical applications, bulk data processing, enterprise resource planning and transaction processing.
NCPDP (National Council for Prescription Drug Programs)
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 Service Vendor
Agent that offers telecommunication connectivity solutions.
Outbound Folder
Place where an EDI transmission is stored for pickup/download. Allows users to download acknowledgment reports from ASK to their PC; i.e. 277CA, 999, TA1).
Payer
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
Unique number that is assigned to an insurance company for the purpose of electronically routing claims.
Payroll Deducted and other Group Premium Payments for Insurance Products
Transaction 820 that allows payroll deductions and other group premium payments for insurance products.
Performing Provider Number
See Rendering Provider Number.
Physical File
Entire file that is transmitted or received. Physical files may contain one or many logical files.
Print Image File
File created by a software system that is in the format of the CMS1500 or UB04.
Proprietary format
Data format specific to a company, industry or other limited group. Proprietary formats do not comply with EDI standards.
Provider
Entity that provides services to the insured.
Provider Taxonomy Code
See Taxonomy Code.
Real-Time Transactions
Processing of transactions the instant each is received by, or entered into, a computer system.
Receiver
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.
Rendering Provider Number
The NPI identifying the health care provider who performed the service.
Secondary Payer
Plan, insurance policy or program that adjudicates second on a claim for medical care.
Secure File Transfer Protocol (SFTP)
Enables secure file transfer capabilities between networked hosts.
Secure Shell (SSH Key)
Cryptographic network protocol for operating network services securely over an unsecured network. Users can implement SSH Keys in order to bypass ASK password requirements.
Submitter ID Number
See Trading Partner Number.
Syntax
Grammar or rules which define the structure of EDI standards.
Tax ID Number
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
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.
Tertiary Payer
Plan, insurance policy or program that adjudicates third on a claim for medical care.
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
Unique number assigned by ASK to identify the entity sending or receiving electronic transactions. May be referred to as Submitter ID.
Trailer record
Record which contains data pertaining to an associated group of records that is immediately preceding it.
Transaction Set
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
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.
URL (Uniform Resource Locator)
Unique reference to a resource that is accessible on the Internet.
Washington Publishing Company (WPC)
Company that publishes the X12N HIPAA Implementation Guides and developed and published the X12N HIPAA Data Dictionary.  http://www.wpc-edi.com/.
X12
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.

 

Updated 08/2017