Glossary

Any computerized comparison of two or more systems of records or a system of
records of non-Federal records for the purpose of (1) establishments or
verifying eligibility or compliance with law and regulations of applicants or
recipients/beneficiaries, or (2) recouping payments or overpayments.

An industry organization that promotes the use of healthcare information systems, including electronic healthcare records.

A payment made by Medicare for services for which another payer is responsible.

Your right to talk with your health care provider without anyone else finding out what you have said.

A covered entity may use or disclose PHI only:

• With the consent of the individual for treatment, payment, or health care operations;
• With the authorization of the individual for all other uses or disclosures;
• As permitted under this rule for certain public policy purposes.

A law that lets some people keep their employer group health plan coverage for a period of time after: the death of your spouse, losing your job, having your working hours reduced, leaving your job voluntarily, or getting a divorce. You may have to pay both your share and the employer’s share of the premium. Generally, you also have to pay an administrative fee.

An annual nationwide survey that is used to report information on Medicare beneficiaries' experiences with managed care plans. The results are shared with Medicare beneficiaries and the public.

A measure of the average change in prices over time in a fixed group of goods and services. In this report, all references to the CPI relate to the CPI for Urban Wage Earners and Clerical Workers (CPI-W).

Data collected through survey or focus group. Surveys may include Medicaid beneficiaries currently or previously enrolled in a MCO or PHP. The survey may be conducted by the State or a contractor to the State.

Data collected through a survey of those Medicaid beneficiaries who are enrolled in the program and have used the services. The survey may be conducted by the State or by the managed care entity (if the managed care entity reports the results to the State).