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P-Q
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
HCFA's term for their pre-HIPAA National Payer ID initiative.
PBX (Private Branch exchange)
An in-house telephone switching system that interconnects telephone extensions to each other, as well as to the outside telephone network. It may include functions such as least cost routing for outside calls, call forwarding, conference calling and call accounting.
PHB
Pharmacy Benefits Manager.
PHS
Public Health Service.
PL or P. L.
Public Law, as in PL 104-191 (HIPAA).
Plan Administrator
The individual responsible for documenting recovery activities and tracking recovery progress.
Plan Sponsor
An entity that sponsors a health plan. This can be an employer, a union, or some other entity.
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 Healthcare organization
PPS
Prospective Payment System.
PRA
The Paperwork Reduction Act.
PRG
Procedure-Related Group.
Pricer or Repricer
A person, a healthcare 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 Healthcare organization or Peer Review Healthcare organization.
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.
