Frequently Used Acronyms and Abbreviations
ALOS----------------------average length of stay
BH-------------------------behavioral health
BISHCA------------------Banking, Insurance, Securities and Health Care Administration
CAP----------------------capitation
CMS---------------------Center for Medicare and Medicaid Services
CMS1500---------------form used to bill professional ancillary services
COB----------------------coordination of benefits
COBA--------------------coordination of benefits Agreement with CMS
COC----------------------certificate of coverage
CPT-4--------------------Current Procedural Terminology
DME-----------------------durable medical equipment
DOB-----------------------date of birth
DOS-----------------------date of service
DRG-----------------------diagnosis related group
DUR-----------------------drug utilization review
Dx-------------------------diagnosis code
EOB-----------------------explanation of benefits
EPO-----------------------Exclusive Provider Organization
FFS------------------------fee for service
HCFA-1500--------------form used to bill professional ancillary services
HEDIS---------------------Health Plan Employment Data and Information Set
HCPCS--------------------HCFA Common Procedural Coding System
HHA------------------------Home Health Agency
HIPAA---------------------Health Insurance Portability and Accountability Act
HMO-----------------------health maintenance organization
HRA------------------------health risk assessment
ICD-9-CM-----------------International Classification of diseases, 9th edition (clinical modifications)
ICF-------------------------intermediate care facility
LOS------------------------length of stay
Medi-Comp--------------Medicare supplemental insurance (now known as Vermont Blue 65 Plan)
MHS-----------------------BCBSVT/TVHP claim processing system
MRA-----------------------magnetic resonance angiography
MRI------------------------magnetic resonance imaging
MRS-----------------------magnetic resonance spectroscopy
NCVO----------------------National Credentialing Verification Organization
NCQA----------------------National Committee on Quality Assurance
Non-Par-------------------non-participating provider
NPI--------------------------National Provider Identifier
OOA------------------------out of area
OON------------------------out-of-network
OOP------------------------out-of-pocket expenses
PAC-------------------------pre-admission certification
PAR-------------------------participating provider
PCP-------------------------primary care practitioner
PHO-------------------------Physician Hospital Organization
PMPM----------------------per member per month
PO---------------------------physician organization
POS-------------------------point of service
PPO-------------------------preferred provider organization
QA---------------------------quality assurance
QI-----------------------------quality improvement
QIC---------------------------quality improvement committee
RA----------------------------remittance advice or referral authorization
SPC-------------------------specialty care practitioner
UB-04-----------------------uniform billing form updated in 2004 and used to bill facility services
UB-92----------------------uniform billing form updated in 1992 and used to bill facility services
UM--------------------------utilization management
UR---------------------------utilization review
Vermont Blue 65 Plan-Medicare supplemental insurance (previously known as Medi-Comp)
