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HCFA Common Procedural Coding System (HCPCS)
A medical code set that identifies health care procedures, equipment, and supplies for claim submission purposes. It has been selected for use in the HIPAA transactions. HCPCS Level I contains numeric CPT codes which are maintained by the AMA. HCPCS Level II contains alphanumeric codes used to identify various items and services that are not included in the CPT medical code set. These are maintained by HCFA, the BCBSA, and the HIAA. HCPCS Level III contains alphanumeric codes that are assigned by Medicaid state agencies to identify additional items and services not included in levels I or II. These are usually called "local codes, and must have "W", "X", "Y", or "Z" in the first position. HCPCS Procedure Modifier Codes can be used with all three levels, with the WA - ZY range used for locally assigned procedure modifiers.
HCFA-1450
HCFA's name for the institutional uniform claim form, or UB-92.
HCFA-1500
HCFA's name for the professional uniform claim form. Also known as the UCF-1500.
Health and Human Services (HHS)
The federal government department that has overall responsibility for implementing HIPAA.
Health care clearinghouse
is a business associate that translates data to or from a standard format in behalf of a covered entity.
Health Care Clearinghouse
Under HIPAA, this is an entity that processes or facilitates the processing of information received from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction, or that receives a standard transaction from another entity and processes or facilitates the processing of that information into nonstandard format or nonstandard data content for a receiving entity.
Health Care Code Maintenance Committee
A healthcare organization administered by the BCBSA that is responsible for maintaining certain coding schemes used in the X12 transactions and elsewhere. These include the Claim Adjustment Reason Codes, the Claim Status Category Codes, and the Claim Status Codes.
Health Care Financing Administration (HCFA)
The HHS agency responsible for Medicare and parts of Medicaid. HCFA has historically maintained the UB-92 institutional EMC format specifications, the professional EMC NSF specifications, and specifications for various certifications and authorizations used by the Medicare and Medicaid programs. HCFA also maintains the HCPCS medical code set and the Medicare Remittance Advice Remark Codes administrative code set.
Health Care Provider Taxonomy Committee
A healthcare organization administered by the NUCC that is responsible for maintaining the Provider Taxonomy coding scheme used in the X12 transactions. The detailed code maintenance is done in coordination with X12N/TG2/WG15.
Health Industry Business Communications Council (HIBCC)
A council of health care industry associations which has developed a number of technical standards used within the health care industry.
Health Informatics Standards Board (HISB)
An ANSI-accredited standards group that has developed an inventory of candidate standards for consideration as possible HIPAA standards.
Health Insurance Association of America (HIAA)
An industry association that represents the interests of commercial health care insurers. The HIAA participates in the maintenance of some code sets, including the HCPCS Level II codes.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
A Federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. Title II, Subtitle F, of HIPAA 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. Also known as the Kennedy-Kassebaum Bill, the Kassebaum-Kennedy Bill, K2, or Public Law 104-191.
Health Level Seven (HL7)
An ANSI-accredited group that defines standards for the cross-platform exchange of information within a health care healthcare organization. HL7 is responsible for specifying the Level Seven OSI standards for the health industry. The X12 275 transaction will probably incorporate the HL7 CRU message to transmit claim attachments as part of a future HIPAA claim attachments standard. The HL7 Attachment SIG is responsible for the HL7 portion of this standard.
Healthcare Financial Management Association (HFMA)
A healthcare organization for the improvement of the financial management of healthcare-related healthcare organizations. The HFMA sponsors some HIPAA educational seminars.
Healthcare Information Management Systems Society (HIMSS)
A professional healthcare organization for healthcare information and management systems professionals.
HEDIC
The Healthcare EDI Coalition.
HEDIS
Health Employer Data and Information Set.
HHA
Home Health Agency.
HHIC
The Hawaii Health Information Corporation.
High Availability
Systems or applications requiring a very high level of reliability and availability. High availability systems typically operate 24x7 and usually require built in redundancy built-in redundancy to minimize the risk of downtime due to hardware and/or telecommunication failures.
HIPAA Data Dictionary or HIPAA DD
A data dictionary that defines and cross-references the contents of all X12 transactions included in the HIPAA mandate. It is maintained by X12N/TG3.
Hot-site
A hot-site is a computer center in a ready state in case of disaster. Hot-sites are commercially available. Cost is dependent on the amount of hardware, floor space required, communications requirements, and services supplied but is generally high, ranging from tens of thousands to hundreds of thousands of dollars per year. Many hot-sites also have initial subscription fees and a disaster declaration charge that prevents the customer from using the facilities for extra processing power during normal operations. A specified set of testing is normally allowed and a charge levied for any extra testing.
HPAG
The HIPAA Policy Advisory Group, a BCBSA subgroup.
HPSA
Health Professional Shortage Area.
Hybrid Entity
A covered entity whose covered functions are not its primary functions.
