Acknowledgment - Notification sent from the receiver to the sender verifying the file was received. The TRN report. See Reports Document
Administrative Simplification (A/S) - 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 over 1,000 companies, 250 technical, trade, labor and consumer organizations, and some 30 government agencies encourages accredited organizations to develop standards and approves those developed under a consensus process as American National Standards.
ANSI Standard - A set of 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) - An organization that has been accredited by ANSI for the development of American National Standards (ANS).
Async - Abbreviation for Asynchronous
Audit Trail - A permanent record of messages transmitted and received.
Autodial - (Automatic Dialing) Capability of a terminal, modem, computer or similar device to place a call over the switched telephone network and establish a connection without operator intervention; also known as auto call.
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 - To mark a document or specific place in a document for later retrieval. A marker or address that identifies a document or a specific place in a document. On the Internet, a way to save an address or make a shortcut to a site you wish to return to or will visit often.
BPS - Bits per second. The measurement of how fast data is moved from one place to another.
Browser - Any client software that is used for looking at World Wide Web resources, the most famous being Netscape's Navigator and Microsoft's Internet Explorer.
Business Associate - A person 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 claim status information. Claims previously submitted may be accessed to find payment information, status of check to be issued, and claim denial information. Batch 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 method by which two computers coordinate their communications.
Companion Document - A document containing instructions to clarify information in the ANSI Implementation Guides (IG). The document should clarify but not contradict requirements in the IG.
Conditional (C) - 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.
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 reduces data field information to its minimum for cost effectiveness.
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.
Dial Up Networking (DUN) - Computer networking that relies on communication through ordinary telephone lines via modem.
Domain Name - The unique name that identifies an Internet site. Domain names have 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 format, which replaces a traditional paper business document.
Edits - Global or payer specific business rules. Transactions will run against these and will reject if an error is detected.
EFT - (Electronic Funds Transfer) Electronically transmitted credit or debit transaction 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 CPU to CPU transmission by a modem or internet connection. It is referred to the ANSI 837 transaction.
Electronic Commerce - The exchange of business information by electronic means.
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. Any communications service that permits the electronic transmission and storage of messages and attached/enclosed 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. Encrypted data is referred to a cipher text.
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.
ERA (Electronic Remittance Advice) - ANSI 835 transaction. Explanation of health care payments from a payer. Must be translated by software. Some software may allow for automatic posting of these transactions.
Errata - 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.
GUI (Graphical User Interface) - A way of communicating with the computer by manipulating icons (pictures) and windows with a mouse. 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 - Electronic claim submission, ANSI 837 transaction. Submission of health care claims for professional, institutional and dental, to payers for payment.
Health Care Request for Review and Response - ANSI 278 transaction. Batch request for claim review.
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 first or top page in a collection of pages that make up a Web site.
HTML (HyperText Markup Language) - The authoring language used to create documents on the World Wide Web.
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.
Insured Eligibility Verification - Health care providers have access to on-line insured eligibility and benefit information. This process allows instant verification of eligibility at the time patients are seen by the provider. Eligibility verification is also available through batch 270/271 transactions.
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.
Internet - A vast, globe-spanning network of networks. The networks communicate with each other based on certain protocols, such as the Transmission Control Protocol (TCP) and the Internet Protocol (IP). Every time you tap into the Internet, your own computer becomes an extension of those networks.
Internet Service Provider (ISP) - A company, which provides access to the Internet for customers.
Intranet - A secure, private network shared by a group of users. An Intranet uses the same type of protocols (TCP/IP) and software found on the public Intranet.
LAN (Local Area Network) - A network of computers that is usually confined to one office building. LANs can be linked together in larger networks called Wide Area Networks (WANs).
Link - On the World Wide Web, a link is reference to another page, which takes you to the other document when you click on it.
List Server - A server that manages email lists for groups of users.
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 an iteration.
Mailbox - An electronic message storage place for data. A customer can retrieve messages from his/her own mailbox and can send messages to other trading partners' mailboxes.
Mainframe Processor - A very large computer capable of supporting hundreds or thousands of users simultaneously.
Mapping - In EDI, it is the association of data field contents from an internal computer system to the field contents in the EDI standard being used. The same mapping takes place in reverse during the receipt of an EDI document.
Modem - Electronic device that converts signals from one form to a form compatible with another kind of equipment, e.g. transmitting computer data over telephone lines.
National Employer ID - A system for uniquely identifying all sponsors of health care benefits. The employer identification number has been chosen as the National Employer ID.
National Payer ID - A system for uniquely identifying all organizations that pay for health care services. Also know 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.
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. Connect thousands of networks together and you have the Internet.
Network Service Vendor - An agent that offers telecommunication connectivity solutions.
NSF (National Standard Format) - A proprietary, 320-byte flat file record format used to submit professional claims. Not a HIPAA standard.
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 - The identification number of a health plan. This number is used to electronically route claims.
Performing Provider Number - See Rendering Provider Number.
Physical File - 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. In TCP/IP and UDP networks, an end point to a logical connection. For example, port 80 is used for HTTP traffic.
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.
Protocol - An agreed-upon format for transmitting data between two devices. The protocol determines the type of error checking to be used: the data compression method; how the sending device will indicate that it has finished; and how the receiving device will indicate it has received the message.
Provider - The entity that provides services to the insured.
Provider Specialty Code - A code indicating the primary specialty of the provider, as defined by the receiver.
Provider Taxonomy Code - See Taxonomy Code.
RA (Remittance Advice) - A computer generated report that explains the processing of a claim. There is usually more than one claim on a RA and can list many different patients.
Real-Time - Describes a system that guarantees an immediate response time.
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. A rejected claim will not be forwarded to the payer, but should be corrected and resubmitted.
Response Reports - Status of transactions. See Reports Document for specific reports.
Search Engine - A program that searches documents for specified keywords and returns a list of the documents where the keywords were found. Each search engine uses a proprietary algorithm to create its indices.
Secondary Payer - The insurance company who has second liability for the resolution of the claim.
Security - A process of system screening that denies access to unauthorized users and protects data from unauthorized uses.
Submitter ID Number - See Trading Partner Number.
Syntax - The grammar or rules which define the structure of EDI standards.
Tax ID Number - A number assigned by the Federal Government to identify a business entity. Also known as the EIN (Employee 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
TCI (Transactions, Code sets and Identifiers) - The portion of the Administrative Simplification provision of HIPAA that refers to the standardization of transactions, codes sets and national identifiers.
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 - The insurance company who has third liability for the resolution of the claim.
TR3(Technical Report Type 3) - See Implementation Guide
Trading Partner - A user who has agreed to exchange electronic business data with another user.
Trading Partner Number - A number assigned by ASK to identify the entity sending or receiving electronic transactions.
Trailer - The portion of the message that follows the actual body and header of the business transaction.
Translator - A software tool for accepting an EDI transmission and converting the data into another format.
Transmission - Data that is electronically sent between computer systems.
Translation - The act of accepting documents in other than standard format and translating them to the EDI standard.
Upload - To transmit data to a central computer from another computer or a computer at a remote location.
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 larger 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.
Web Site - A location of the World Wide Web. Each Web site contains a home page, which is the first document users see when they enter the site. The site might also contain additional documents and files.
WWW (World Wide Web) - A system of Internet servers that support specially formatted documents. The documents are formatted in a language called HTML (Hyper Text Markup Language) that supports links to other documents, as well as graphics, audio, and video files. This means you can jump from one document to another simply by clicking on specific locations.
XML (Extensible Markup Language) - Allows designers to create their own customized tags, enabling the definition, transmission, validation and interpretation of data between applications and organizations.
X12 - An ANSI-accredited group that defines EDI standards for many American industries, including health care insurance. Most of the electronic transaction standards mandated or proposed under HIPAA are X12 standards.
ASK WEB GLOSSARY