Abbreviations and acronyms

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ABA Applied Behavioral Analysis (related to autism mandate)
ACA Affordable Care Act
ACES Adjudication and Claims Entry System
ACG Adjusted Clinical Groups (John Hopkins)
ACH Average call handled
  Automatic Clearing House
ACO Accountable Care Organization
ADA American Dental Association
  Americans with Disabilities Act
AD&D Accidental Death & Dismemberment
ADEA Age Discrimination in Employment Act
AGI Adjusted Gross Income
AHIP America's Health Insurance Plans
AHP Association Health Plan Groups
AICK Advance Insurance Company of Kansas
ALE Applicable Large Employer
AMA American Medical Association
AMGH Air Medical Group Holdings
AMT Alternative Minimum Tax
APO Automatic Payment Option
APRN Advanced Practice Registered Nurse
APTC Advanced Premium Tax Credit
AQC Administrative Quality Committee
ARC Administrative Review Committee
ARRA American Recovery and Reinvestment Act
ASC Ambulatory Surgery Center
ASD Autism Spectrum Disorder
ASL Aggregate Stop Loss
ASO Administrative Services Only
AV Actuarial Value
AVR Asset Valuation Reserve
AWP Average Wholesale Price




B2B Business to business
BAR Build A Rate (QHP (Qualified Health Plan))
BBKS BlueCross BlueShield Kansas Solutions
BCBSA Blue Cross Blue Shield Association
BCBSKS Blue Cross and Blue Shield of Kansas
BCBSKSF Blue Cross and Blue Shield of Kansas Foundation
BCS Breast Cancer Screening
BDC Blue Distinction Centers
BDE Benefit Design Enhancement
BDTC Blue Distinction Total Care
BE BluesEnroll
BGT Benefit Generation Table
BHI Blue Health Initiatives
  Blue Health Intelligence
BlueCard National program administered by BCBSA that provides Blue Members with access to providers
BOHA Board of Healing Arts
BPO Business Process Outsourcing
BPT Bid Pricing Tool
BRD Business Required Documents




CAHPS Consumer Assessment of Healthcare Providers and Systems
CAP Competitive Allowance Program
  Corrective Action Plan
CAQH Council for Affordable Quality Healthcare
CAUTI Catheter-Associated Urinary Tract Infections
CBF Capitation Bulk Format
CDAD Chronic Disease Alliance of Kansas
CDC Comprehensive Diabetes Care Measures
CCIIO Center for Consumer Information and Insurance Oversight
CCIT Contract Change Implementation Team
CDC Centers for Disease Control and Prevention
  Comprehensive Diabetes Care
CDHC Consumer-Driven Health Care
CDHP Consumer Directed Health Plan
CEO Chief Executive Officer
CFO Chief Financial Officer
CHIE Certified Healthcare Insurance Executive
CHS Catholic Health Systems
CID Civil Investigation Demand
CIH Customer Identity Hub
CIO Chief Information Officer
CIWP Company Imposed Waiting Period
CLABS Central Line Associated Blood Stream Infection
CMO Chief Medical Officer
CM Case Management
CMM GF Comp Major Med Grandfathered
CMS Centers for Medicare and Medicaid Services
CMXO Chief Marketing and Experience Officer
CO Contract Overview
COB Coordination of Benefits
COBRA Consolidated Omnibus Reconciliation Act of 1986
COC Continuity of Care Document
COINS Coinsurance
COO Chief Operations Officer
CPI Consumer Price Index
CQIC Clinical Quality Improvement Committee
CRG Clinical Risk Groups (Treo (vendor) uses this 3M reporting)
CSC Customer Service Center
CSI Customer Service Inquiry
CSR Cost Sharing Reduction
CVP Customer Value Partners
CX Customer Experience




DAC Dental Advisory Committee
DCA Deferred Compensation Agreement
DED Deductible
DIT Data Integrity Tool
DM Disease Management
DME Durable Medical Equipment
DOL Department of Labor
DPOA Durable Power of Attorney
DRG Diagnosis Related Grouping
DTO Drug Therapy Opportunities
DUR Drug Utilization Review




E&M Evaluation and Management
EAFE Europe, Asia and Far East
EAPG Enhanced Ambulatory Patient Groupings
EAP Employee Assistance Program
EBP Episode Based Payments
ECA Executive Clinical Analysis
ECHO Extension for Community Health Care Outcome
ECP Essential Community Provider
EDI Electronic Data Interchange
EE Electronically Enrolled
EEO Equal Employment Opportunity
EFT Electronic Funds Transfer
EHB Essential Health Benefits
ELT Executive Leadership Team
  Extract, Load, Transform
EOB Explanation of Benefits
EPA Electronic Provider Access
EPIP Employee Performance Incentive Program
EPO Exclusive Provider Organization
ERISA Employee Retirement Income Security Act of 1974
ESN Extended Supply Network
ESRD End Stage Renal Disease
ERM Enterprise Risk Management




FAST Facilitated Adoption of Sustained Transfer
FEIN Federal Employer Identification Number
FEP Federal Employee Program
FFM Federally Facilitated Marketplace
FFS Fee for Service
FI Fully Insured
FLSA Fair Labor Standards Act
FMA Family Medicine Associates
FMLA Family and Medical Leave Act
FOI Freedom of Information
FPL Federal Poverty Level
FQHC Federally Qualified Health Center
FSA Flexible Spending Account
FSMB Federal State Medical Board
FWA Fraud, Waste & Abuse




GAC Group Application Certificate
GF Grandfathered
GINA Genetic Information Nondiscrimination Act
GL Group Leader
GSM Group Setup Maintenance
GUR Group Utilization Report




HAC Hospital Advisory Committee
HAE Hereditary Angioedema
HBE Health Benefit Exchange
HCE Highly Compensation Employee
HCTC Health Coverage Tax Credit
HEDIS Healthcare Effectiveness Data and Information Set
HEN Hospital Engagement Network
HDHP High Deductible Health Plan
HHS Department of Health and Human Services
HIAA Health Insurance Association of America
HICS Health Insurance Casework System
HIM Health Insurance Marketplace
HIOS Health Insurance Oversight System
HIP Hospital Indemnity Plan
HIPAA Health Insurance Portability and Accountability Act of 1996
HIT Health Information Technology
HITECH Health Information Technology for Economic and Clinical Health Act
HIX Health Insurance Exchange
HMO Health Maintenance Organization
HMS Health Metric Systems, Inc.
HRA Health Reimbursement Arrangement/Account
  Health Risk Assessment
HRBC Health Risk Based Capital
HSA Health Savings Account




IBNR Incurred But Not Reported
ICD International Classification of Disease
ID Identification Card
IMR Interest Maintenance Reserve
IRO Independent Review Organization
ISL Individual Stop Loss
ITS Inter-Plan Teleprocessing Services (network that is used to administer BlueCard)
IVR Interactive Voice Recording




JD Juris Doctorate




KAFP Kansas Academy of Family Physicians
KAHP Kansas Association of Health Plans
KAMU Kansas Association of Medically Underserved
KCA Kansas Chiropractic Association
KDB Kansas Dental Board
KDHE Kansas Department of Health & Environment (oversees Kansas Health Insurance Information System and is a government department)
KECH Kansas Employer Coalition on Health Care
KEIT Kansas Educational Insurance Trust
KFMC Kansas Foundation for Medical Care
KHA Kansas Hospital Association
KHC Kansas Healthcare Collaborative
KHDS Kansas Health Data System
KHEN Kansas Hospital Engagement Network
KHIE Kansas Health Information Exchange
KHIN Kansas Health Information Network
KHIT Kansas Health Information Technology Advisory Council
KHC Kansas Health Collaborative
KID Kansas Insurance Department
KOMA Kansas Association of Osteopathic Medicine
KSBOHA Kansas State Board of Healing Arts
KSBN Kansas State Board of Nursing
KSBSRB Kansas Behavioral Sciences Regulatory Board




LACIE Lewis and Clark Information Exchange
LOB Line of Business
LRBC Life Risk Based Capital
LTC Long-Term Care
LTD Long-Term Disability




MA Medicare Advantage
MAC Medical Advisory Committee
  Maximum Allowable Cost (at Prime Mail)
MAP Maximum Allowable Payment
MBI Medicare Beneficiary Identifier
MDL Multi-District Litigation
MEC Minimum Essential Coverage
MET Multiple Employer Trust
MEWA Multiple Employer Welfare Arrangement
MFA Multi-factor Authentication
MHP Mental Health Parity
MLR Medical Loss Ratio
MMI Master Member Index
MMR Measles, Mumps, Rubella Vaccination
MO Modus Operandi
MOC Maintenance of Certification (Licensing certification of doctors)
MOG Measurement Operations Group
MOOP Maximum Out of Pocket
MP Minimum Premium
MSA Medical Savings Account
  Metropolitan Statistical Areas
MSN Medicare Summary Notice
MSP Medicare Secondary Payer
MSPP Multi-State Plan Program (MSP Program)
MSSP Medicare Shared Savings Program
MTM Member Touchpoint Measures
MV Minimum Value




NACD National Association of Corporate Directors
NAIC National Association of Insurance Commissioners
NCCT National Consumer Cost Transparency
NCPE National Council of Physician and Pharmacist Executives
NCQA National Committee on Quality Assurance
NGF Non-grandfathered
NMSN National Medical Child Support Notice
NOL Net Operating Loss
NOPP-GLB Notice of Privacy Practices – Gramm-Leach Bliley
NPI National Provider Identifier
NQF National Quality Foundation
NSD National Standard Date




OB Obstetrics
OBRA Omnibus Budget Reconciliation Act
OHCA Organized Health Care Arrangement
OOA Out of Area
OON Out of Network
OPPI Outpatient Practice Process Improvement
OPL Other Party Liability
ORSA Own Risk Solvency Assessment
OPM Office of Personnel Management
OSAF Outpatient Substance Abuse Facilities
OTC Over the Counter




PA Plan Administrator
PAD Pre-service, Admission & Discharge
PBM Pharmacy Benefit Management
PCMH Patient Centered Medical Home
PBP Plan Benefit Package
PCORI Patient-Centered Outcome Research Institute
PCP Primary Care Provider
PCPCC Patient-Centered Primary Care Collaborative
PCPM Per Contract Per Month
PEO Professional Employer Organization
PHI Protected Health Information
PII Personal Identifiable Information
PIT Product Initiative Team
P&L 500 Committee Purchase & Lease 500 Committee
PMPM Per Member Per Month
POS Point of Service
PPA Potentially Preventable Admissions
PPACA Patient Protection and Affordable Care Act
PPE's Potentially Preventable Events
PPM Provider Performance Management
PPO Preferred Provider Organization
PPR Potentially Preventable Readmissions
PPV Potentially Preventable Emergency Room Visits
PQM Physician Quality Measures
PrOACT Problem, Objectives, Alternatives, Consequences and Tradeoffs
PS Plan Sponsor
PSAO's Pharmacy Service Administration Organization
PSO Provider-Sponsored Organizations




QBRP Quality Based Reimbursement Program
QDRO Qualified Domestic Relations Order
QHI Quality Health Indicators
QHP Qualified Health Plan
QIO Quality Improvement Organization
QMCSO Qualified Medical Child Support Order
QMF Query Management Facility
QRS Quality Rating System
QUIP Quality and Utilization Improvement Process




3 R's Risk Adjustment, Reinsurance, Risk Corridors
RAF Rate Adjustment Factor
RBC Risk Based Capital
RBRVU Resource Based Relative Value Units
RCIN Rural Clinical Integrated Network
RFI Request for Information
RFP Request for Proposal
RFR Request for Reinstatement
ROI Return on Investment
RCM Requirements Confirmation Memo
RTC Residential Treatment Center
RVU Relative Value Unit




SADP Stand Alone Dental Program
SAR Summary Annual Report
SBAR Small Business Account Representatives
SBAS Small Business Account Support
SBC Summary of Benefits & Coverage
SBC GF Summary of Benefit Coverage Grandfathered
SBM State-based Marketplace
SCOTUS Supreme Court of the United States
SDOH Social Determinants of Health
S-HIP Secure Hospital Indemnity Program
SGIR Small Group Initial Rating
SC Steering Committee
SEHP State Employees Health Plan
SERFF System for Electronic Rate and Form Filing
SERP Supplemental Executive Retirement Plan
SEP Special Enrollment Period
SGRR Small Group Rate Reform
SHOP Small Business Health Options Program
SIU Special Investigations Unit
SME Subject Matter Expert
SMM Summary of Material Modifications
SOA Strategic Opportunity Analysis
  Society of Actuaries
SOC 1 Service Organization Controls Report (relevant to User Entites' Internal Control over Financial Reporting)
SOC 2 Service Organization Controls Report (relevant to Security, Availability, Processing Integrity Confidentiality or Privacy)
SOK State of Kansas
SPD Summary Plan Description
SQM Service Quality Measurement Group (Customer Service)
SSO Single Sign On
STD Short-term Disability




TAGS Trait, Age, Gender, Suite (Reporting score used by MDInsight (vendor)
TIPS Treasury Inflation Protected Securities
TOS Type of Service
TIPS Third Party Administrator




UAT User Access Test
UCL Unpaid Claims Liability
UCR Usual Customary and Reasonable
  Unpaid Claims Reserve
UM Utilization Management
UPD Universal Provider Data Source
USERRA Uniformed Services Employment and Re-employment Rights Act




VBID Value-Based Insurance Design
VBP Value-Based Program
VBR Value-Based Reimbursement
VEBA Voluntary Employees' Beneficiary Association
VIS Value Index Score




WHCRA Women's Health and Cancer Rights Act