Even if you are a professional insurance agent, you will often hear industry acronymns used in passing that you don’t understand. So, here’s a list of common abbreviations that I’ve been compiling, which sooner or later you’ll likely hear as you grow in your insurance career.
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- AAA – Area Agency on Aging
- AAC – Actual Acquisition Cost
- ABA – Applied Behavioral Analysis
- ABE – Agents, Brokers and Broker Entities
- ABP – Alternative Benefit Plan
- ACA – Affordable Care Act
- ACC – Accountable Care Collaborative
- ACF – Administration for Children & Families
- ACIP – Advisory Committee Practice (Centers for Disease Control & Prevention)
- ACO – Accountable Care Organization
- ACS – American Community Survey
- ADA (1973) – Americans with Disabilities Act
- ADA (1975) – Age Discrimination Act
- ADD – Attention Deficit Disorder
- ADHD – Attention Deficit Hyperactivity Disorder
- ADL – Activity of Daily Living
- AEP – Annual Enrollment Period
- AFDC – Aid to Families with Dependent Children
- AFMO – Aggregator Field Marketing Organization
- AHCCCS – Arizona Health Care Cost Containment System
- AHIP – American’s Health Insurance Plans (training certifications)
- AHRQ – Agency for Healthcare Research & Quality
- AIDS – Aquired Immune Deficiency Syndrome
- AKS – Anti Kickback Statute
- ALM – Agent Lifecycle Management
- AMA – American Medical Association
- AML – Anti Money Laundering
- AMP – Average Manufacturer Price
- ANCSA – Alaska Native Claims Settlement Act
- ANOC – Annual Notice of Change
- AOA – Agent Online Application enrollment
- AOC – Assignment of Commissions
- AOR – Agent of Record
- APC – Ambulatory Payment Classification
- APE – Agent Portal External
- APIs – Application Programming Interfaces
- APRN – Advanced Practice Registered Nurse
- APS – Annual Person Summary
- APTC – Advance Premium Tax Credit
- ARP – American Rescue Plan
- ARPA – American Rescue Plan Act
- ARRA – American Recovery & Reinvestment Act
- ARTS – Addiction and Recovery Treatment Services
- ASAM – American Society of Addiction Medicine
- ASC – Ambulatory Surgical Center
- ASP – Average Sales Price
- ASPE – Assistant Secretary of Planning and Evaluation
- AV – Actuarial Value
- AVS – Asset Verification System
- AWP – Average Wholesale Price
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- BA – Business Associate(s)
- BAR – Batch Auto Re-enrollment
- BAV – Bonus Accumulation Value
- BBA97 – Balanced Budget Act of 1997
- BCBSFL – Blue Cross Blue Shield of Florida (Florida Blue)
- BHH – Behavioral Health Homes
- BHO – Behavioral Health Organization
- BHP – Basic Health Program
- BIP – Balancing Incentive Payment Program
- BMI – Body Mass Index
- BNP – Banco National de Paris
- BNPP – Banco National de Paris and Paribas
- BNPIMAD – Banco National de Paris Multi Asset Diversified
- BOE – Basis of Eligibility
- BOB – Book of Business
- BOR – Broker of Record
- BRC – Business Reply Card
- BRFSS – Behavioral Risk Factor Surveillance System
- BSA – Bank Secrecy Act
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- CAA – Consolidated Appropriations Act (2023)
- CACs – Certified Application Counselors, volunteers
- CAD – Coronary Artery Disease
- CAM – Customer Acquisition Marketing
- CAH – Critical Access Hospital
- CAHMI – Child and Adolescent Health Measurement Initiative
- CAHPS – Consumer Assessment of Healthcare Providers & Systems
- CARF – Commission on Accreditation of Rehabilitation Facilities
- CARL – CIGNA Agent Resource Line
- CARTS – CHIP Annual Reporting Template System
- CBES – Childrens Health Budget and Expenditure System
- CBO – Congretional Budget Office
- CBT – Cognitive Behavioral Therapy
- CCBHC – Certified Community Behavioral Health Clinic
- CCIIO – Consumer Information & Insurance Oversight
- CCIP – Chronic Care Improvement Plan
- CCN – CMS Certification Number
- CCO – Coordinated Care Organization
- CCPD – Continuous Cycling Peritoneal Dialysis
- CCR – Cost to Charge Ratio
- CCW – Chronic Condition Data Warehouse
- CDC – Centers for Discease Control & Prevention
- CDD – Customer Due Diligence Rule
- CDL – Clinical Diagnostic Laboratory
- CDOs – CAC Designated Organizations
- CDPS – Chronic Illness and Disability Payment System
- CDT – Current Dental Terminology
- CEHRT – Certified Electronic Health Record Technology
- CEU – Continuing Education Unit
- CF – Conversion Factor
- CFACTS – CMS FISMA Controls Tracking System
- CHAMPVA – Civilian Health and Medical Program – Dept. of Veterans Affairs
- CHF – Congestive Heart Failure
- CHIP – Children’s Health Insurance Program
- CHIPRA – Children’s Health Insurance Program Re-Authorization Act
- CHNA – Community Health Needs Assessment
- CHP – Capital Health Plan
- CIA – Children’s Insurance Agreement
- CiC – Change in Circumstances
- CICA – Consumer Insurance Contracts Act
- CICA – Citizens Insurance Corporation of America
- CIN – Client ID Number
- CIP – Customer Identification Program
- CLAS – Culturally & Linguistically Appropriate Services
- CLD – Chronic Lung Disease
- CLI – Catastrophic Loss Index
- CLI – Certificate of Liability Insurance
- CLI – Continental Life Insurance (Aetna)
- CLIA – Clinical Laboratory Improvement Ammendments (1988)
- CLRD – Chronic Liver or Renal Disease
- CMC – Comprehensive Managed Care
- CMCS – Center for Medicaid and CHIP Services
- CMHC – Community Mental Health Center
- CMIP – Comprehensive Medicaid Integrity Plan
- CMP – Civil Money Penalty(s)
- CMS – Centers for Medicare & Medicaid Services
- CNA – Client Needs Assessment
- CNM – Certified Nurse Midwife
- CNOM – Costs Not Otherwise Matchable
- CNS – Clinical Nurse Specialist
- COBRA – Consolidated Omnibus Budget Reconciliation Act (1985)
- CODEP – Coordination Only Dual Eligible Plans (MIPPA DSNP)
- COPD – Chronic Obstructive Pulminary Disease
- CORD – Childhood Obesity Research Demonstration
- CORF – Comprehensive OUtpatient Rehabilitation Facilities
- CPE – Certified Public Expenditure
- CPI – Center for Program Integrity
- CPIU – Consumer Price Index for all Urban Consumers
- CPNP – Certified Pediatric Nurse Practitioner
- CPS – Current Population Survey
- CPT – Current Procedural Terminology (American Medical Association)
- CRA – Civil Rights Act (1964)
- CRNA – Certified Registered Nurse Anesthetists
- CRNP – Certified Registered Nurse Practioner
- CSB – CIGNA Suplemental Benefits
- CSG – (Kellog quote tool)
- CSHCN – Children with Special Health Care Needs
- CSNP Chronic Care Special Needs Plan
- CSR – Cost Sharing Reductions
- CSR – Corporate Social Responsibility
- CT – Computerized Tomography
- CTA – Computerized Tomography Angiography
- CTM – Complaint Tracking Module (CMS)
- CVAT – Cash Value Accumulation Test
- CVD – Cardio Vascular Disorder
- CY – Calendar Year
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- DE – Direct Enrollment pathway
- DEFRA – Deficit Reduction Act
- DFAS – Defense Financing & Accounting Service
- DHRM – DSH Health Reform methodology
- DM – Diabetes Mellitus
- DME – Durable Medical Equipment
- DMIs – Data Matching Issues
- DNP – Doctor of Nursing Practice
- DOI – Department of Insurance
- DOJ – Department of Justice
- DOL – Department of Labor
- DRA – Deficit Reduction Act (2021)
- DRG – Diagnosis Related Group
- DSNP – Dual Eligible Special Needs Plan
- DSRIP – Delivery System Reform Incentive Payment
- DSRIP – Delivery System Reform Incentive Payment Performing Provider System
- DUR – Drug Utilization Review
- DxCG – Diagnostic Cost Group Risk Adjustment Model
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- EAC – Estimated Acquisition Cost
- EAP – Enrollment Assistance Personnel assisters, employed by Cognosante for “Medicaid unwinding” in AZ, FL, IL, LA, MI, MT, NC, OK, SD, TN, TX & UT
- EAPG – Enhanced Ambulatory Patient Group
- EB-HRA – Excepted Benefit HRA
- ECP – Essential Community Provider
- ED – Emergency Department
- EDC – External Distribution Channel
- EDE – Enhanced Direct Enrollment pathway
- EDI – Electronic Data Interchange
- EDN – Eligibility Determination Notice
- EFMAP – Enhanced Federal Medical Assistance Percentage
- EFT – Electronic Funds Transfer
- EGHP – Employer/Union Group Health Plan
- EGWP – Employer Group Waiver Plans (Florida Blue)
- EHB – Essential Health Benefits
- EHR – Electronic Health Record
- EKG – Electrocardiogram
- ELE – Express Lane Eligibility
- E/M – Evaluation and Management
- EMTALA – Emergency Medical Treatment and Active Labor Act
- E&O – Errors and Omissions
- EOB – Explanation of Benefits
- EOC – Evidence of Coverage
- EOP – Explanation of Payments
- EPO – Exclusive Provider Organization
- EPSDT – Early and Periodic Screening, Diagnostics and Treatment
- ERA – Electronic Remittance Advice (AKA EOB)
- EQR – External Quality Review
- EQRO – External Quality Review Organization
- ERD – Expected Reinsurer Deficit
- ERISA – Employee Retirement Income Security Act of 1974
- ESC – Employer Sponsored Coverage
- ESI – Employer Sponsored Insurance
- ESRD – End Stage Renal Disease
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- FACI – Federal Advisory Committee on Insurance
- FACI – Field Access to Customer Information
- FAI – Financial Alignment Initiative
- FATF – Financial Action Task Force
- FBDE – Federal Benefit Dual Eligible
- FBMI – Florida Blue Medicare Inc.
- FCA – False Claims Act
- FCC – Federal Communication Commission
- FCHCO – Federal Coordinated Health Care Office
- FCL – Florida Combined Life (Subidiary of Blue Cross)
- FCPA – Foreign Corrupt Powers Act
- FCRA – Fair Credit Reporting Act
- FDA – Food and Drug Administration
- FDR – First Tier, Downstream & Related Entity
- FEP – Federal Employee Program
- FERA – Fraud Enforcement Recovery Act
- FinCEN – Financial Crimes Enforcement Network
- FFCRA – Families First Coronavirus Response Act
- FFL – Family First Life IMO
- FFMs – Federally Facilitated Marketplaces, the Marketplace, “Health Insurance Marketplace”, “Exchange”
- FFP – Federal Financial Participation
- FFS – Fee For Service
- FHCP – Florida Health Care Plans, Inc. (acquired by Florida Blue)
- FIDE – Fully Integrated Dual Eligible Plans (DSNP)
- FIDESNP – Fully Integrated Dual Eligible Special Needs Plan
- FIFO – First In First Out
- FISMA – CMS Federal Information Security Management Act
- FMAP – Federal Medical Assistance Percentage
- FMO – Field Marketing Organizations
- FMR – Financial Management Report
- FOA – Family Opportunity Act
- FPG – Federal Poverty Guidelines
- FPL – Federal Poverty Level
- FQHC – Federally Qualified Health Center
- FSA – Flexible Spending Account
- FTC – Federal Trade Commission
- FTE – Full Time Equivalent
- FTI – Federal Tax Information
- FTP – Failure To Pay
- FTP – File Transfer Protocol
- FUL – Federal Upper Limit
- FY – Fiscal Year
- FYC – First Year Commission
- FYE – Full Year Equivalent
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- GA – General Agency
- GA – General Agent
- GAO – Government Accountability Office
- GCIA – Grandchild Insurance Agreement
- GDP – Gross Domestic Product
- GINA – Genetic Information NonDiscrimination Act
- GIO – Guaranteed Insurability Option
- GIPO – Guaranteed Issuance Policy Option
- GLIR – Guaranteed Lifetime Income Rider
- GLP – Guideline Level Premium
- GME – Graduate Medical Education
- GMO – General Marketing Organization
- GPP – Global Payment Program
- GPT – Guideline Premium Test
- GRIT – Great Rebound In the face of Tribulation
- GSA – General Services Administration
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- HA – Health Assessment
- HCAC – Health Care Acquired Condition
- HCBS – Home and Community Based Service
- HCC – Hierarchical Condition Category
- HCERA – Health Care and Education Reconciliation Act
- HCFA – Health Care Financing Administration
- HCFAC – Health Care Fraud and Abuse Control Program
- HCMS – Hierarchy and Compensation Management System
- HCPCS – Health Care Common Procedure Coding System
- HCRIS – Health Care Cost Reporting Information System
- HCRP – High Cost Risk Pool
- HCS – Hearing Care Solutions (CIGNA)
- HCUP – Health Care Cost and Utilization Project
- HEAT – Health Care Fraud Prevention and Enforcement Action Team
- HEDIS – Health Care Effectiveness Data and Information Set
- HHA – Home Health Aid
- HHS – Department of Health and Human Services
- HIPAA – Health Insurance Portability and Accountability Act (1996)
- HICN – Health Insurance Claim Number
- HICS – Hospital Incident Command System
- HIDE – Highly Integrated Dual Eligible plans (DSNP)
- HIDESNP – Highly Integrated Dual Eligible Special Needs Plan
- HIE – Health Information Exchange
- HIO – Health Insuring Organization
- HIP – Health Insurance Plan
- HIPAA – Health Insurance Portability and Accountability Act
- HIT – Health Information Technology
- HITECH – Health Information Technology for Economic & Clinical Health
- HIU – Health Insurance Unit
- HIV – Human Immunodeficiency Virus
- HIX – Health Insurance Exchange
- HMA – Health Matching Accounts
- HMAS – Health Matching Account Services, Inc.
- HMO – Health Maintenance Organization
- HMOA – Health Maintenance Organization Act
- HMRA – Health Matching Reimbursement Accounts
- HMS – Home Mortgage Series
- HNW – High Net Worth
- HOPD – Hospital Outpatient Department
- HPMS – Health Plan Management System
- HPSA – Health Professional Shortage Area
- HRA – Health Risk Assessment
- HRAs – Health Reimbursement Arrangements
- HRMS – Health Reform Monitoring Survey
- HRR – Hospital Referral Region
- HRSA – Health Resources and Services Administration
- HSA – Health Savings Account
- HSI – Health Services Initiative
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- IADL – Instrumental Activity of Daily Living
- IBNRS – Incurred But Not Reported Survey
- ICA – Independent Career Agent
- ICA – (State) Information Counseling and Assistance
- ICD – International Classification of Diseases
- ICEP – Initial Coverage Election Period
- ICF – Intermediate Care Facility
- ICFID – Intermideiate Care Facility for those with Intellectual Disabilities
- ICHRA – Individual Coverage HRA
- ICL – Initial Coverage Limit
- ICP – Individualized Care Plan
- ICT – Interdisciplinary Care Team
- ICU – Intensive Care Unit
- IDD – Individuals with Intellectual Disabilities (Not IID)
- IDR – Integrated Data Repository
- IDV – Individual Dental & Vision
- IEP – Initial Enrollment Period
- IFP – Individual & Family Plan
- IGT – Inter Governmental Transfer
- IHS – Indian Health Service
- IMD – Institutions for Mental Diseases
- IME – Indirect Medical Education
- IMMAA – Individual Medicare Marketing Authorization Addendum
- IMO – Independent Marketing Organization
- IMU – Index of Medical Underservice
- INN – In Network
- INN – International Nonproprietary Name
- IOM – Institute of Medicine
- IOP – Intensive Outpatient Program
- IPA – Independent Provider Association
- IPPS – Inpatient Prospective Payment System
- IPUMS – Integrated Public Use Microdata Series
- IRC – Internal Revenue Code
- IRE – Independent Review Entity
- IRR – Internal Rate of Return
- IRS – Internal Revenue Service
- ISNP – Institutional Special Needs Plan
- ISS – Information Security Services
- IVR – Integrated Voice Recording
- KYC – Know Your Customer
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- LADC – Licensed Alcohol and Drug Counselor
- LEA – Local Education Agency
- LEAN – Landmark Electronic Application Navigator
- LEP – Limited English Proficiency
- LEP – Late Enrollment Penalty
- LIFO – Last In First Out
- LIHP – Low Income Health Program
- LIS – Low Income Subsidy
- LM – Licensed Midwife
- LMO – Legally Mandated Organization
- LMS – Learning Management System
- LOA – Line of Authority
- LOA – Licensed Only Agent
- LOC – Level of Care
- LPI – Low Performing Icon
- LPR – Legal Permanent Resident
- LTC – Long Term Care
- LTSS – Long Term Services and Supports
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- MA – Medicare Advantage
- MACBIS – Medicaid and CHIP Business Information Solutions
- MACPAC – Medicaid and CHIP Payment and Access Commission
- MACRA – Medicaid and CHIP Reauthorization Act
- MAGI – Modified Adjusted Gross Income
- MAP – Measure Applications Partnership
- MAPD – Medicare Advantage Prescription Drug Plan
- MAS – Maintenance Assistance Status
- MAT – Medication Assisted Treatment
- MAX – Medicaid Analytic Extract
- MBES – Medicaid Budget and Expenditure System
- MBI – Medicare Beneficiary Identifier
- MBI – Medicaid Buy In
- MCBS – Medicare Current Beneficiary Survey
- MCCA – Medicare Catastrophic Coverage Act
- MCE – Managed Care Entity
- MCH – Maternal and Child Health
- MCHD – MultiCultural Healthcare Distinction
- MCHB – Maternal and Child Health Bureau
- MCMG – Medicare Communication & Marketing Guidelines
- MCO – Managed Care Organization
- MEC – Minimum Essential Coverage
- MEC – Modified Endowment Contract
- MED – Morphine Equivalent Dose
- MEDIC – Medicare Integrity Contractor
- MEDPAC – Medicare Payment Advisory Commission
- MEMA – Member Enrollment Mix Adjustment
- MEPS – Medical Expenditure Panel Survey
- MEPSHC – Medical Expenditure Panel Survey – Household Component
- MEPSIC – Medical Expenditure Panel Survey – Insurance Component
- MEQS – Medicaid Eligibility Quality Control System
- MFCU – Medicaid Fraud Control Unit
- MFP – Money Follows the Person
- MFSDB – Medicare Fee Schedule Data Base
- MGA – Managing General Agency
- MGA – Master General Agent
- MH – Mental Health
- MHPA – Mental Health Parity Act (1996)
- MHPAEA – Mental Health Parity and Addiction Equity Act (2008)
- MH/SUD – Mental Health/Substance Use Disorder
- MIC – Medicaid Integrity Contractor
- MIG – Medicaid Integrity Group
- MII – Medicaid Integrity Institute
- MIP – Medicaid Integrity Program
- MIPPA – Medicare Improvement for Patients and Providers Act (CODEP)
- MITA – Medicaid Information Technology Architecture
- MLMS – Marketplace Learning Management System
- MLR – Medical Loss Ratio (80% small group/ 85% large group)
- MLTSS – Managed Long Term Services and Supports
- MMA – Medicare Modernization Act
- MMCDCS – Medicaid Managed Care Data Collection System
- MMCO – Medicaid Medicare Coordination Office
- MMDMP – Medicare Medicaid Data Match Program (Medi-Medi Program)
- MMG – Medicare Marketing Guidelines
- MMIS – Medicaid Management Information Systems
- MMLR – Minimum Medical Loss Ratio
- MMNA – Monthly Maintenance of Need Allowance
- MMP – Medicare-Medicaid Plan
- MMR – Marketing MisRepresentation
- MMSEA – Medicair Medicaid and SCHIP Extension Act (2007)
- MOC – Method of Care
- MOE – Maintenance of Effort
- MOEN – Marketplace Open Enrollment Notice
- MOMS – Maternal Opiate Medicine Support Project
- MOU – Memorandum of Understanding
- MOUD – Medications to Treat Opioid Use Disorder
- MPR – Minimum Participation Rate
- MPRN – Minimum Participation Rate Navigator
- MRA – Magnetic Resonance Angiogram
- MRI – Magnetic Resonance Imaging
- MRS – Magnetic Resonance Spectroscopy
- MS – Multiple Sclerosis
- MSA – Metropolital Statistical Area
- MSB – Money Services Business
- MSIS – Medicaid Statistical Information System
- MSP – Managed Service Provider
- MSP – Medicare Savings Program
- MSTAT – Medicaid State Technical Assistance Team
- MTM – Medication Therapy Management
- MU – Medicaid Unwinding – (special qualifications from COVID 4/1-12/31/23).
- MUA – Medically Underserved Area
- MUP – Medically Underserved Population
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- NADAC – National Average Drug Acquisition Cost Survey
- NAIC – National Association of Insurance Commissioners
- NAMCS – National Ambulatory Medical Care Survey
- NAMD – National Association of Medicaid Directors
- NCANDS – National Child Abuse and Neglect Data System
- NCCI – National Correct Coding Initiative
- NCHS – National Center for Health Statistic
- NCQA – National Committee for Quality Assurance
- NDAA – National Defense Authorization Act
- NDC – National Drug Code
- NEADS – Now, Enjoy, Add/Altar, Decision, Summary anaylsis
- NEDS – Nationwide Emergency Department Sample
- NEHRS – National Electronic Health Records Survey
- NEMT – Non-Emergency Medical Transportation
- NEPQ – Neuro Emotional Persuasion Questioning
- NF – Nursing Facility
- NFLOC – Nursing Facility Level of Care
- NHAMCS – National Hospital Ambulatory Care Survey
- NHE – National Health Expenditures
- NHIS – National Health Interview Survey
- NHRA – Nursing Home Reform Act
- NHSC – National Health Service Corps
- NICU – Neonatal Intensive Care Unit
- NIDA – National Institute on Drug Abuse
- NIPR – National Insurance Producer Registry
- NIPT – Non Institutional Provider Team
- NIRT – National Institutional Reimbursement Team
- NIS – Nationwide Inpatient Sample
- NLC – Next Level Contracting
- NMA – National Marketing Alliances
- NMHSS – National Mental Health Services Survey
- NMO – National Marketing Organization
- NOPP – Notice of Privacy Practice
- NPI – National Provider Identifier
- NPN – National Producer Number
- NPPES – National Plan and Provider Enumeration System
- NPR – Net Patient Revenue
- NPS – Net Promoter Score
- NSCAW – National Survey of Child and Adolescent Well Being
- NSHC – National Survey of Childrens’ Health
- NSCSHCN – National Survey of Children with Special Health Care Needs
- NSDUH – National Survey of Drug Use and Health
- NSLP – National School Lunch Program
- NSSATS – National Survey of Substance Abuse Treament Services
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- OACT – Office of the Actuary
- OASI – Old Age and Survivors Trust Fund
- OBA – Office of Benefits Administration
- OBA – Officer’s Benefit Association
- OBGYN – Obstetrician and Gyncologist
- OBRA – Omnibus Budget Reconciliation Act (1990)
- OCR – Office for Civil Rights
- ODWCC – Outpatient Departmental Weight Cost to Charge
- OE – Open Enrollment
- OE – Operating Expenses
- OEP – Open Enrollment Period
- OEPI – Open Enrollment Period Institutional
- OEV – Outbound Enrollment Verification
- OFAC – Office of Foreign Assets Control
- OFM – Office of Financial Management
- OFR – Omnibus Final Rule (HHS)
- OHI – Other Health Insurance
- OIG – Office of the Inspector General
- OMB – Office of Management and Budget
- OON – Out of Network
- OOP – Out of Pocket
- OPD – Outpatient Department
- OPFS – Outpatient Prospective Fee Schedule
- OPM – Office of Personnel Management
- OPPC – Other Provider Preventable Conditions
- OPPS – Outpatient Prospective Payment System
- OSB – Optional Supplemental Benefits
- OT – Occupational Therapy
- OTC – Over the Counter
- OTP – Opioid Treatment Program
- OTP – Over the Phone
- OUD – Opioid Use Disorder
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- P4P – Pay For Performance
- P&P – Privacy Policies & Procedures
- PA – Physician Assistant
- PAC – Provider AssoCiate Level Variable ten digit code
- PACE – Program of All Inclusive Care for the Elderly
- PAHP – Prepaid Ambulatory Health Plans
- PAPE – Payment Amount Per Episode
- PBM – Pharmacy Benefit Manager
- PBP – Plan Benefit Package
- PBRHC – Provider Based Rural Health Clinic
- PCA – Personal Care Attendant
- PCC – Primary Care Clinician
- PCCM – Primary Care Case Management
- PCLs – Plan Category Limitations
- PCMH – Patient Centered Medical Home
- PCP – Preimary Care Provider
- PCPCH – Patient Centered Primary Care Home
- PCPCP – Primary Care Partial Capitation Provider
- PCPM – Per Contract Per Month
- PCRI – Primary Care Rate Increase
- PDB – Producer Data Base
- PDL – Preferred Drug List
- PDM – Periodic Data Matching – Medicare
- PDM – Death PDM; Medicaid PDM, CHIP PDM
- PDMP – Prescription Drug Monitoring Program
- PDP – Prescription Drug Plan
- PDSS – Part D Senior Savings
- PECL – Pre Enrollment Check List
- PECOS – Provider, Enrollment, Chain & Ownership System
- PEP – Politically Exposed Person
- PERM – Payment Error Rate Measurement Program
- PET – Positron Emission Tomography
- PFFS – Private Fee For Service
- PHE – Public Health Emergency
- PHI – Personal Health Information
- PHP – Prepaid Health Plan
- PII – Personally Identifiable Information
- PMH – Pregnancy Medical Home
- PMP – Primary Medical Provider
- PMPM – Per Household Member Per Month
- PMPY – Per Member Per Year
- PNA – Personal Needs Allowance
- PO – Privacy Officer
- POA-HC – Power of Attorney for Health Care
- POS – Point of Service
- POS DIR – Point of Sale Direct
- PPACA – Patient Protection Affordable Care Act
- PPC – Provider Preventable Conditions
- PPO – Preferred Provider Organization
- PPS – Prospective Payment System
- PQMP – Pediatric Quality Measures Program
- PT – Physical Therapy
- PTC – Premium Tax Credit
- PTC – Permission To Contact
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- QDWI – Qualified Disabled and Working Individual
- QHP – Qualifying Health Plan
- QI – Qualifying Individual
- QIO – Quality Improvement Organizations
- QMB – Qualified Medicare Beneficiary
- QMB + – Qualified Medicare Beneficiary Plus Full Medicaid Benefits
- QPP – Quality Payment Program
- QRTP – Qualified Residential Treatment Program
- QSEHRA – Qualified Small Employer Health Reimbursement Arrangement
- RA (1973) – Rehabilitation Act
- RAC – Recovery Audit Contract
- RADV – Risk Adjustment Data Valuation
- RATE – Remote Access Telephonic Enrollment
- RBRVS – Resource Based Relative Value Scale
- RBRVU – Resource Based Relative Value Units
- RCCO – Regional Care Collaborative Organizations
- RCO – Regional Compliance Officer
- RDU – Renal Dialysis Units
- RFI – Request For Information
- RFP – Request For Proposal
- RHC – Rural Health Clinic
- RICS – Reduction in Cost Share Allowance (CIGNA)
- RMO – Regional Marketing Organization
- RNFA – Registered Nurse First Assistants
- RNHCI – Religious Non-Medical Health Care Institution
- ROY – Rest of Year
- RSSA – Registered Social Security Analyst
- RTS – Ready to Sell
- RVU – Relative Value Unit
- RxDC – Prescription Drug Data Collection
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- SADP – Stand Alone Dental Plan
- SAM – System for Award Management (General Services Administration)
- SAMHSA – Substance Abuse and Mental Health Services Administration
- SAR – Suspicious Activity Report
- SB – Summary of Benefits
- SBHC – School Based Health Center
- SBHCTC – Small Business Health Care Tax Credit
- SBIRT – Screening Brief Intervention and Referral to Treatment
- SBC – Summary of Benefits and Coverage
- SBMs – State Based Marketplaces
- SBM-FPs – State-based Marketplaces on the Federal Platform
- SBP – Survivor Benefit Plan
- SC – Service Connected (VA)
- SCI – Spinal Cord Injury
- SDAP – Sales Development Action Program
- SDMI – Severe Disabling Mental Illness
- SDN – Specially Designated Nationals
- SED – Severe or Serious Emotional Disturbance
- SEDD – State Emergency Department Database
- SEDS – Statistical Enrollment Data System
- SEPs – Special Enrollment Periods
- SFPFS – Senior Financial or Political Figures
- SFY – State Fiscal Year
- SGA – Substantial Gainful Activity
- SGA – Supervising General Agency
- SGRP – Social and Government Referral Program
- SHADAC – State Health Access Data Assistance Center
- SHIP – State Health Insurance Assitance Program
- SHOP – Small Business Health Options Program
- SIL – Special Income Level
- SIM – State Information Models Program
- SIPP – Survey of Income and Program Participation
- SIU – Special Investigations Unit
- SLCSP – Second Lowest Cost Silver Plan (Benchmark plan premium)
- SLMB – Specified Low-Income Medicare Beneficiary
- SLMB + – Specified Low-Income Medicare Beneficiary Plus Full Medicaid Benefits
- SLP – Speech and Language Pathology
- SMAC – State Maximum Allowable Cost
- SMD – State Medicaid Doctor
- SMI – Serious Mental Illness
- SMMM – Severe Maternal Mortality and Morbidity
- SNAP – Supplemental Nutrition and Assistance Programs
- SNF – Skilled Nursing Facility
- SNP – Special Needs Plan
- SOA – Scope of Appointment
- SOTA – State Operations and Technical Assistance Initiative
- SOU – Statement of Understanding
- SPA – State Plan Amendment
- SPAP – State Pharmaceutical Assistance Program
- SPMI – Serious Persistent Mental Illness
- SPRY – State Plan Rate Year
- SSA – Social Security Administration
- SSBCI – Special Supplemental Benefits for the Chronically Ill
- SSBG – Social Services Block Grant
- SSC – Social Services Coordinator
- SSDI – Social Security Disability Insurance
- SSEPHI – Security Standards for Electronically Protected Health Information
- SSI – Supplemental Security Income
- ST – Speech Therapy
- SUA – Specified Unlawful Activity
- SUD – Substance Use Disorder
- SUPPORT – Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act
- SVIs – SEP Verification Issues
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- TAF – T-MSIS Analystic Files
- TAMRA – Technical And Miscelaneous Revenue Act
- TANF – Temporary Assistance for Needy Families
- TAP – Technical Advisory Panel
- TAT – Turn Around Time
- TBI – Traumatic Brain Injury
- TBI/SCI – Traumatic Brain or Spinal Cord Injury
- TCPA – Telephone Consumer Protection Act
- TEFRA – Tax Equity and Fiscal Responsibility Act
- TEFT – Testing Experiences and Functional Tools Demonstration
- TFL – Tricare for Life
- TIA – Transient Ischemic Attack
- TMA – Transitional Medical Assistance
- TMSIS – Transformed Medicaid Statistical Information System
- TNC – Transportation Network Companies
- TPL – Third Party Liability
- TPMO – Third Party Marketing Organization
- TPO – Treatment, Payment, (healthcare) Operations
- TRICARE – DOD (Dept. of Defense) healthcare program
- TTWIIA – Ticket to Work and Work Incentives Improvement Act
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- U&C – Usual and Customary
- UC – Uncompensated Care
- UCC – Uncompensated Care Cost
- UCR – Usual and Customary Rate
- UDS – Uniform Data System
- UHICA – United Healthcare Insurance Company of America
- UPL – Upper Payment Limit
- URA – Unit Rebate Amount
- USC – Usual Source of Care
- USPSTF – U.S. Preventative Services Task Force
- VA – Department of Veteran Affairs
- VAIS – Value Added Items & Services
- VBE – Value Based Enrollments
- VBID – Value Based Insurance Design
- VBP – Value Based Purchasing
- VFC – Vaccines For Children Program
- VHA – Veterans Health Administration (Army, Navy, Marines, Air Force, Coast Guard)
- VMS – Vendor Management System (MSP Software)
- WAC – Wholesale Acquisition Cost
- WCC – Weighted Cost to Charge
- WDI – Working Disabled Individual
- WIC – Special Supplemental Nutrition Program for Women Infants and Children
- ZPIC – Zone Program Integrity Contractor