EDI Related Links

American Dental Association (ADA)
Professional association of dentists committed to the public's oral health, ethics, science, and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards.

American Health Information Management Association (AHIMA)
Dynamic professional association that represents more than 40,000 specially educated health information management professionals who work throughout the health care industry.

American Medical Association (AMA)
Promotes professionalism in medicine and sets standards for medical education, practice and ethics.

Health Care Compliance Association (HCCA)
Forum for healthcare professionals involved in compliance service all segments of the health care industry.

National Association of Insurance Commissioners (NAIC)
The organization of insurance regulators from the 50 states, the District of Columbia, and the four U.S. Territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate.

EDI

Data Interchange Standards Association (DISA)
A not-for-profit organization that supports the development and use of electronic business interchange standards in electronic commerce.

Workgroup for Electronic Data Interchange (WEDI)
Information about improving health care through Electronic Commerce.

Washington Publishing Company (WPC)
Manages and distributes EDI information, primarily in the form of documentation for organizations that develop, maintain, and implement EDI standards.

The Washington Publishing Company (WPC) assists several organizations in the maintenance and distribution of HIPAA-related code lists external to the X12 family of standards. The lists have different release schedules and are maintained by groups including the National Uniform Claim Committee (Provider Taxonomy) and the by the Centers for Medicare and Medicaid Services (Remittance Advice Remark Codes).

Among the HIPAA-Related Code Lists you can view online at the WPC website:

Addenda to the ICD-9-CM
The National Center for Health Statistics posts addenda to the ICD-9-CM at this location.

Government

Health Care Financing Administration (HCFA) or Centers for Medicare and Medicaid Services (CMS)
The federal agency within the U.S. Department of Health and Human Services which runs the Medicare and Medicaid programs. 

U.S. Government Printing Office (GPO)
The focal point for printing, binding, and information dissemination for the entire Federal community.

HEALTH INSURANCE TERMS

Affordable Care act

The Affordable Care Act (ACA), sometimes called Obamacare, is a federal law designed to make health care more affordable, accessible and of higher quality.

COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

health insurance marketplace (exchange)

The government Website (healthcare.gov) where you can purchase health insurance and see if you qualify for a tax credit (subsidy) to help pay premiums and out-of-pocket costs. 

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy.

tax credit

Financial assistance from the government that helps those who are eligible pay for health insurance. Eligibility is generally determined by household income and family size.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider.