Ch. 8 Terms Flashcards
Accredited Standards Committee X 12
Committee was formed by the American National Standards Institute (ANSI) to develop the US standards body for the cross industry development, maintenance and publication of electronic data exchange standards.
Accredited Standards Comm. X12 Version 5010
The X12 HIPAA transaction standards have been upgraded to a version called the ASC X12 Version 5010.
Application service provider
(APS) A practice management system available over the internet in which data are housed on the server of the ASP but the accounts are managed by the health care provider’s staff.
Back Up
A duplicate data file, such as a CD to record data; it may be used to complete or redo the operation if the primary equipment fails.
Batch
Group of claims for different patients sent at the same time from one facility.
Business Associate Agreement
Contract between the provider and a clearinghouse that submits the electronic claims on behalf of the provider. A trading partner agreement is another type of contract.
Cable modem
Modem used to connect a computer to a cable television system that offers online services.
Clearinghouse
Entity that receives the electronic data from the provider’s office and translate the info into a standard format. The clearninghouse is the middle man between the provider and the insurance company; after sorting through the data, the clearinghouse will transmit the claims electronically
Code sets
The allowable set of codes that anyone could use to enter into a specific space (field) on a form.
Covered entity
An entity that transmits health info in electronic form in connection with a transaction covered by HIPAA. The covered entity may be 1) a health care coverage carrier, 2) a clearinghouse, 3) a healthcare provider, like a doctor
Data elements
Medical code sets used uniformly to document why patients are seen (diagnosis) and what is done to them during their encounter (procedure). They can be required (used in compliance with HIPAA) or it can be Situational (item depends on the data content).
Digital Subscriber Line
High speed connection through a telephone line jack and usually means accessing the internet.
Direct data entry
Keying claim info directly into the payer system by accessing the internet.
Electronic funds transfer
A paperless computerized system enabling funds to be debited, credited or transferred, eliminating the need for personal handling of checks.
Electronic data interchange (EDI)
Exchange of data in a standardized format through computer systems (ex: health insurance claims). Electronic transmissions are sent encrypted so that they can’t be opened and read if received by the wrong person.
