Glossary

National rates for each 6 home health disciplines based on historical claims data. Used in payment of LUPAs and calculation of outliers.

An organization, chaired and hosted by the American Hospital Association, that maintains the UB-92 hardcopy institutional billing form and the data element specifications for both the hardcopy form and the 192-byte UB-92 flat file EMC format. The NUBC has a formal consultative role under HIPAA for all transactions affecting institutional health care services.

An organization, chaired and hosted by the American Medical Association, that maintains the HCFA-1500 claim form and a set of data element specifications for professional claims submission via the HCFA-1500 claim form, the Professional EMC NSF, and the X12 837. The NUCC also maintains the Provider Taxonomy Codes and has a formal consultative role under HIPAA for all transactions affecting non-dental non-institutional professional health care services.

When the Decision Memorandum is issued, the NCA is considered closed. However, the policy change is not effective until the NCD is issued.

The decision memorandum provides the reasons supporting an NCD and announces CMS's intent to issue an NCD. Prior to any new or modified policy taking effect, CMS must first issue a Manual Transmittal, CMS ruling or Federal Register Notice, giving specific directions to our claims-processing contractors. That manual transmittal, or other issuance, which includes the effective date, is the actual NCD. If appropriate, the Agency must also change billing and claims processing systems and issue related instructions to allow for payment. The NCD will be published in the Medicare National Coverage Determinations Manual. Policy changes become effective as of the date listed in the Manual Transmittal that announces the National Coverage Determinations Manual revision.

An NCA is considered new if CMS has received a coverage request or a current NCD is being edited. The "N" at the end of the tracking number (e.g., CAG-0000N) indicates a new NCA.

A pending NCA is one currently under review. The Decision Memorandum has not yet been issued. The subject may or may not be an existing NCD.

A pending NCA is one currently under review. The Decision Memorandum has not yet been issued. The subject may or may not be an existing NCD.

A formal reconsideration can be requested if the requestor presents documentation that meets either of the following criteria: additional medical material or scientific information that was not considered during the initial review; or arguments that our conclusion materially misinterpreted the existing evidence at the time the NCD was made. The ôRö at the end of the tracking number (e.g, CAG-0000R) indicates a reconsideration. Further reconsiderations are annotated with a number after the ôRö, e.g., R2, R3, etc.

A NCPDP format for use by low-volume dispensers of pharmaceuticals, such as nursing homes. The Secretary of HHS adopted Version 1.0 of this format as a standard transaction.