ASC – Accredited Standards Committee
CAQH – Council on Affordable Quality Healthcare
CCD – Corporate Credit or Debit
CORE- Required Minimum CCD+ Re-association Data Elements:
- Information transmitted by a Health Plan to a Healthcare Provider for the purpose of re-associating a Healthcare EFT Transaction with an electronic remittance advice.
- CORE - Required Minimum CCD+ Re-association Data Elements includes:
- Effective Entry Date field
- Amount field
- Payment Related Information field of the CCD Entry
CTX – Corporate Trade Exchange
EFT – Electronic Funds Transfer
Electronic Remittance Advice (ERA): – an electronic file that is sent from the Health Plan payer to the Healthcare Provider that can be used to post and close accounts receivable. This is called an ERA or sometimes referred to as an Explanation of Benefits (EOB).
Government programs: – The government may also act as the insurer under sponsored programs such as:
- Medicare - 65 and older or certain disabilities
- Medicaid – low income individuals and families
- Tricare -Uniformed service members, retirees and their families
HHS – US Department of Health and Human Services
Healthcare EFT Transaction: – a CCD+ Entry originated by a Health Plan to a Healthcare Provider with respect to a healthcare claim payment. Under this definition, a Healthcare EFT Transaction must include one addenda record that contains 835 TRN (Re-association Trace Number) data segment within the Payment Related Information field.
- An individual or group plan that provides, or pays the cost of, medical care.
- The insurance company receives the claim from the service provider and determines eligibility, compensation rate for the provider, deductibles and co-pays. The insurance company makes payment to the provider, and sends an Explanation of Benefits (EOB) statement to the patient and or the provider. Some example are Blue Cross and Blue Shield, Aetna, United Healthcare and Kaiser Permanente.
Healthcare Provider: – a provider of medical or health services, and any other person or organization who furnishes, bills, or is paid for healthcare in the normal course of business.
HIPAA: – the federal law that protects personal medical information and recognizes the rights to relevant medical information of family caregivers and others directly involved in providing or paying for care.
Medical Clearinghouses: – aggregators (senders and receivers) of mountains of medical claim information almost all of which is managed by software.
Tilde (“~”) data segment terminator: – indicates the end of any data segment carried in the Addenda Record of the CCD Entry (alternative to backslash). The tilde is commonly used in the healthcare industry to indicate the end of a healthcare data segment.
ODFI – Originating Depository Financial Institution
RDFI – Receiving Depository Financial Institution