esMD+Glossary

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**This page will be used to document terms and definitions for all three work streams for esMD** Provider Profile Authentication (PPA) Structured Content Author of Record

=Provider Profile Authentication=

Use Case 1 - Provider Registration with Payer

 * ** Alternate ID ** - An alternate ID can be used if a Registration Requester does not have an NPI.
 * ** Atypical Service Provider ** - Entities or individuals that are not defined as a health care provider; however, they do provide services that are payable by some health plans. Examples are taxi drivers, auto mechanics and carpenters.
 * **CERT** - Collect documentation and perform reviews on a statistically-valid random sample of Medicare FFS claims to produce an annual error rate.
 * ** ESI ** - Electronic Services Information
 * **FISMA** - A mandated U.S. Federal law that provides a framework to improve information security of federal agencies, contractors, and other entities that handle federal data. Security components include: Risk Assessment, Security policies and procedures, Subordinate plans, Security testing, Remedial action and Security incident handling.
 * ** Medicare Administrative Contractors (MACs) - ** Process claims submitted by physicians, hospitals, and other health care providers/suppliers, and submit payment to those providers in accordance with Medicare rules and regulations. This includes identifying and correcting underpayments and overpayments.
 * **National Provider Identifier (NPI)** - The National Provider Identifier (NPI) is a standard required under HIPAA. The NPI is a unique, 10-digit identification number for health care providers that is free of any personal or identifying information. Covered health care providers, health plans, and health care clearinghouses must use the NPI in administrative and financial transactions (e.g., claims submission) that are adopted under HIPAA.
 * **PERM** - Measures improper payments in Medicaid and CHIP and produces error rates for each program. The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the fiscal year (FY) under review. It is important to note the error rate is not a "fraud rate" but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements.
 * **Recovery Audit Contractors (RACs)** - The RACs, are responsible for identifying improper Medicare payments that may have been made to healthcare providers and that were not detected through existing program integrity efforts.
 * **Wet Signatures** - Physically signing a document by hand using an ink pen
 * **X12 Wrapper**- The standard for the development and maintenance of Electronic Data Interchange standards for the United States
 * **Zone Program Integrity Contractors (ZPICs)** - Identify cases of suspected fraud and take appropriate corrective actions.

Use Case 2 - Sending of the electronic Medical Documentation Request (eMDR)


=Structured Content=
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=Author of Record=
 * TBD

include component="page" wikiName="siframework" page="space.template.inc_contentleft_end" Examples are taxi drivers, auto mechanics and carpenters