Glossary

Refers to the exchange of routine business transactions from one computer to another in a standard format, using standard communications protocols.

An organization that tests transactions for consistency with the HIPAA requirements, and that accredits health care clearinghouses.

A flat file format used to transmit or transport claims, such as the 192-byte UB-92 Institutional EMC format and the 320-byte Professional EMC NSF.

This term usually refers to a flat file format used to transmit or transport claims, such as the 192-byte UB-92 Institutional EMC format and the 320-byte Professional EMC NSF.

A process that large employers can use to complete their requirements for supplying IRS/SSA/HCFA Data Match information electronically.

Any of several electronic formats for explaining the payments of health care claims.

Refers to the process whereby an individual is determined to be eligible for health care coverage through the Medicaid program. Eligibility is determined by the State. Eligibility data are collected and managed by the State or by its Fiscal Agent. In some managed care waiver programs, eligibility records are updated by an Enrollment Broker, who assists the individual in choosing a managed care plan to enroll in.

You are eligible for premium-free (no cost) Medicare Part A (Hospital Insurance) if:

• You are 65 or older and you are receiving, or are eligible for, retirement benefits from Social Security or the Railroad Retrirement Board, or
• You are under 65 and you have received Railroad Retirement disability benefits for the prescribed time and you meet the Social Security Act disability requirements, or
• You or your spouse had Medicare-covered government employment, or
• You are under 65 and have End-Stage Renal Disease (ESRD).

If you are not eligible for premium-free Medicare Part A, you can buy Part A by paying a monthly premium if:

• You are age 65 or older, and
• You are enrolled in Part B, and
• You are a resident of the United States, and are either a citizen or an alien lawfully admitted for permanent residence who has lived in the United States continuously during the 5 years immediately before the month in which you apply.

You are automatically eligible for Part B if you are eligible for premium-free Part A. You are also eligible for Part B if you are not eligible for premium-free Part A, but are age 65 or older AND a resident of the United States or a citizen or an alien lawfully admitted for permanent residence. In this case, you must have lived in the United States continuously during the 5 years immediately before the month during which you enroll in Part B.

Care given for a medical emergency when you believe that your health is in serious danger when every second counts.