A HIPAA Glossary, continued
M - P

Contents

Part I (A HIPAA Glossary) gives general definitions and explanations of HIPAA-related terms and acronyms.

Part II (Consolidated HIPAA Administrative Simplification Final Rule Definitions) shows all definitions included in the final HIPAA A/S rules as of 01/20/2001.

Part III (Purpose & Maintenance) is self-explanatory.

Part I: A HIPAA Glossary

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Maintain or Maintenance: See Part II, 45 CFR 162.103.

Marketing: See Part II, 45 CFR 164.501.

Massachusetts Health Data Consortium (MHDC): An organization that seeks to improve healthcare in New England through improved policy development, better technology planning and implementation, and more informed financial decision making.

Maximum Defined Data Set: Under HIPAA, this is all of the required data elements for a particular standard based on a specific implementation specification. An entity creating a transaction is free to include whatever data any receiver might want or need. The recipient is free to ignore any portion of the data that is not needed to conduct their part of the associated business transaction, unless the inessential data is needed for coordination of benefits. Also see Part II, 45 CFR 162.103.

MCO: Managed Care Organization.

M+CO: Medicare Plus Choice Organization.

Medicaid Fiscal Agent (FA): The organization responsible for administering claims for a state Medicaid program.

Medicaid State Agency: The state agency responsible for overseeing the state’s Medicaid program.

Medical Code Sets: Codes that characterize a medical condition or treatment. These code sets are usually maintained by professional societies and public health organizations. Compare to administrative code sets.

Medical Records Institute (MRI): An organization that promotes the development and acceptance of electronic health care record systems.

Medicare Contractor: A Medicare Part A Fiscal Intermediary, a Medicare Part B Carrier, or a Medicare Durable Medical Equipment Regional Carrier (DMERC).

Medicare Durable Medical Equipment Regional Carrier (DMERC): A Medicare contractor responsible for administering Durable Medical Equipment (DME) benefits for a region.

Medicare Part A Fiscal Intermediary (FI): A Medicare contractor that administers the Medicare Part A (institutional) benefits for a given region.

Medicare Part B Carrier: A Medicare contractor that administers the Medicare Part B (Professional) benefits for a given region.

Medicare Remittance Advice Remark Codes: A national administrative code set for providing either claim-level or service-level Medicare-related messages that cannot be expressed with a Claim Adjustment Reason Code. This code set is used in the X12 835 Claim Payment & Remittance Advice transaction, and is maintained by the HCFA.

Memorandum of Understanding (MOU): A document providing a general description of the responsibilities that are to be assumed by two or more parties in their pursuit of some goal(s). More specific information may be provided in an associated SOW.

MGMA: Medical Group Management Association.

MHDC: See the Massachusetts Health Data Consortium.

MHDI: See the Minnesota Health Data Institute.

Minimum Scope of Disclosure: The principle that, to the extent practical, individually identifiable health information should only be disclosed to the extent needed to support the purpose of the disclosure.

Minnesota Health Data Institute (MHDI): A public-private partnership for improving the quality and efficiency of heath care in Minnesota. MHDI includes the Minnesota Center for Healthcare Electronic Commerce (MCHEC), which supports the adoption of standards for electronic commerce and also supports the Minnesota EDI Healthcare Users Group (MEHUG).

Modify or Modification: Under HIPAA, this is a change adopted by the Secretary, through regulation, to a standard or an implementation specification. Also see Part II, 45 CFR 160.103.

More Stringent: See Part II, 45 CFR 160.202.

MOU: See Memorandum of Understanding.

Master Patient or Person Index (MPI): Whether in paper or electronic format, may be considered the most important resource in a healthcare facility because it is the link tracking patient, person, or member activity within an organization (or enterprise) and across patient care settings. The MPI identifies all patients who have been treated in a facility or enterprise and lists the medical record or identification number associated with the name. An index can be maintained manually or as part of a computerized system. Retention of entries depends upon the MPI's use. Typically, those for healthcare facilities are retained permanently, while those for insurers, registries, or others may have different retention periods. a database of all the patients ever registered (within reason) at a facility; name, demographics, insurance, next of kin, etc.

MR: Medical Review.

MRI: See the Medical Records Institute.

MSP: Medicare Secondary Payer.

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NAHDO: See the National Association of Health Data Organizations.

NAIC: See the National Association of Insurance Commissioners.

NANDA: North American Nursing Diagnoses Association.

NASMD: See the National Association of State Medicaid Directors.

National Association of Health Data Organizations (NAHDO): A group that promotes the development and improvement of state and national health information systems.

National Association of Insurance Commissioners (NAIC): An association of the insurance commissioners of the states and territories.

National Association of State Medicaid Directors (NASMD): An association of state Medicaid directors. NASMD is affiliated with the American Public Health Human Services Association (APHSA).

National Center for Health Statistics (NCHS): A federal organization within the CDC that collects, analyzes, and distributes health care statistics. The NCHS maintains the ICD-n-CM codes.

National Committee for Quality Assurance (NCQA): An organization that accredits managed care plans, or Health Maintenance Organizations (HMOs). In the future, the NCQA may play a role in certifying these organizations’ compliance with the HIPAA A/S requirements. The NCQA also maintains the Health Employer Data and Information Set (HEDIS).

National Committee on Vital and Health Statistics (NCVHS): A Federal advisory body within HHS that advises the Secretary regarding potential changes to the HIPAA standards.

National Council for Prescription Drug Programs (NCPDP): 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. Also see NCPDP … Standard.

National Drug Code (NDC): A medical code set that identifies prescription drugs and some over the counter products, and that has been selected for use in the HIPAA transactions.

National Employer ID: A system for uniquely identifying all sponsors of health care benefits.

National Health Information Infrastructure (NHII): This is a healthcare-specific lane on the Information Superhighway, as described in the National Information Infrastructure (NII) initiative. Conceptually, this includes the HIPAA A/S initiatives.

National Patient ID: A system for uniquely identifying all recipients of health care services. This is sometimes referred to as the National Individual Identifier (NII), or as the Healthcare ID.

National Payer ID: A system for uniquely identifying all organizations that pay for health care services. Also known as Health Plan ID, or Plan ID.

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

National Provider File (NPF): The database envisioned for use in maintaining a national provider registry.

National Provider Registry: The organization envisioned for assigning National Provider IDs.

National Provider System (NPS): The administrative system envisioned for supporting a national provider registry.

National Standard Format (NSF): Generically, this applies to any nationally standardized data format, but it is often used in a more limited way to designate the Professional EMC NSF, a 320-byte flat file record format used to submit professional claims.

National Uniform Billing Committee (NUBC): An organization, chaired and hosted by the American Hospital Association, that maintains the UB-92 hardcopy institutional billing form and the data element specifications for both the hardcopy form and the 192-byte UB-92 flat file EMC format. The NUBC has a formal consultative role under HIPAA for all transactions affecting institutional health care services.

National Uniform Claim Committee (NUCC): An organization, chaired and hosted by the American Medical Association, that maintains the HCFA-1500 claim form and a set of data element specifications for professional claims submission via the HCFA-1500 claim form, the Professional EMC NSF, and the X12 837. The NUCC also maintains the Provider Taxonomy Codes and has a formal consultative role under HIPAA for all transactions affecting non-dental non-institutional professional health care services.

NCHICA: See the North Carolina Healthcare Information and Communications Alliance.

NCHS: See the National Center for Health Statistics.

NCPDP: See the National Council for Prescription Drug Programs.

NCPDP Batch Standard: An NCPDP standard designed for use by low-volume dispensers of pharmaceuticals, such as nursing homes. Use of Version 1.0 of this standard has been mandated under HIPAA.

NCPDP Telecommunication Standard: An NCPDP standard designed for use by high-volume dispensers of pharmaceuticals, such as retail pharmacies. Use of Version 5.1 of this standard has been mandated under HIPAA.

NCQA: See the National Committee for Quality Assurance.

NCVHS: See the National Committee on Vital and Health Statistics.

NDC: See National Drug Code.

NHII: See National Health Information Infrastructure.

NOC: Not Otherwise Classified or Nursing Outcomes Classification.

NOI: See Notice of Intent.

Non-Clinical or Non-Medical Code Sets: See Administrative Code Sets.

North Carolina Healthcare Information and Communications Alliance (NCHICA): An organization that promotes the advancement and integration of information technology into the health care industry.

Notice of Intent (NOI): A document that describes a subject area for which the Federal Government is considering developing regulations. It may describe the presumably relevant considerations and invite comments from interested parties. These comments can then be used in developing an NPRM or a final regulation.

Notice of Proposed Rulemaking (NPRM): A document that describes and explains regulations that the Federal Government proposes to adopt at some future date, and invites interested parties to submit comments related to them. These comments can then be used in developing a final regulation.

NPF: See National Provider File.

NPI: See National Provider ID.

NPRM: See Notice of Proposed Rulemaking.

NPS: See National Provider System.

NSF: See National Standard Format.

NUBC: See the National Uniform Billing Committee.

NUBC EDI TAG: The NUBC EDI Technical Advisory Group, which coordinates issues affecting both the NUBC and the X12 standards.

NUCC: See the National Uniform Claim Committee.

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OCR: See the Office for Civil Rights.

Office for Civil Rights: The HHS entity responsible for enforcing the HIPAA privacy rules.

Office of Management & Budget (OMB): A Federal Government agency that has a major role in reviewing proposed Federal regulations.

OIG: Office of the Inspector General.

OMB: See the Office of Management & Budget.

Open System Interconnection (OSI): A multi-layer ISO data communications standard. Level Seven of this standard is industry-specific, and HL7 is responsible for specifying the level seven OSI standards for the health industry.

Organized Health Care Arrangement: See Part II, 45 CFR 164.501.

OSI: See Open System Interconnection.

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PAG: See Policy Advisory Group.

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

PAYERID: CMS (formerly known as HCFA)'s term for their pre-HIPAA National Payer ID initiative.

Payment: See Part II, 45 CFR 164.501.

PCS: See ICD.

PHB: Pharmacy Benefits Manager.

PHI: See Protected Health Information.

PHS: Public Health Service.

PL or P. L.: Public Law, as in PL 104-191 (HIPAA).

Plan Administration Functions: See Part II, 45 CFR 164.504.

Plan ID: See National Payer ID.

Plan Sponsor: An entity that sponsors a health plan. This can be an employer, a union, or some other entity. Also see Part II, 45 CFR 164.501.

Policy Advisory Group (PAG): A generic name for many work groups at WEDI and elsewhere.

POS: Place of Service or Point of Service.

PPO: Preferred Provider Organization

PPS: Prospective Payment System.

PRA: The Paperwork Reduction Act.

PRG: Procedure-Related Group.

Pricer or Repricer: A person, an organization, or a software package that reviews procedures, diagnoses, fee schedules, and other data and determines the eligible amount for a given health care service or supply. Additional criteria can then be applied to determine the actual allowance, or payment, amount.

PRO: Professional Review Organization or Peer Review Organization.

Protected Health Information (PHI): See Part II, 45 CFR 164.501.

Provider Taxonomy Codes: 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.

Psychotherapy Notes: See Part II, 45 CFR 164.501.

Public Health Authority: See Part II, 45 CFR 164.501.

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