Current through September 24, 2024
As used in these rules, unless the context requires
otherwise:
(1) Uniform Claim Forms
(a) "UB-92, HCFA-1450 or CMS-1450" means the
health insurance claim form maintained by HCFA/CMS for use by institutional
care providers. Currently this form is known as the UB-92.
(b) "HCFA-1500 or CMS-1500 (12-90)" means the
health insurance claim form maintained by HCFA/CMS for use by health care
providers.
(c) "American Dental
Association, 1999 Version 2000" means the uniform dental claim form approved by
the American Dental Association (ADA) for use by dentists, as amended or
updated by the American Dental Association.
(d) "NCPDP" means the National Council for
Prescription Drug Program's claim form or its electronic counterpart.
(2) Uniform Claim Codes
(a) "ASA Codes" means the codes contained in
the ASA Relative Value Guide developed and maintained by the American Society
of Anesthesiologists to describe anesthesia services and related
modifiers.
(b) "CDT-3 Codes" means
the current dental terminology prescribed by the American Dental Association,
including the terminology updates and revision issued in the future by the
American Dental Association.
(c)
"CPT-4 Codes" ("Level I Codes") means the Physicians' Current Procedural
Terminology, Fourth Edition, published by the American Medical
Association.
(d) "ICD-9-CM Codes"
means the diagnosis and procedure codes in the International Classification of
Diseases, Ninth Revision, clinical modifications published by the U.S.
Department of Health and Human Services.
(e) "NDC" means the National Drug Codes of
the Food and Drug Administration.
(f) "UB-92 Codes" means the code structure
and instructions established for use by the National Uniform Billing
Committee.
(g) "HCPCS Codes"
("Level II Codes") means the Health Care Financing Administration's Common
Procedure Coding System. This means national codes developed by HCFA/CMS to
supplement CPT codes. They include physical services not included in CPT as
well as non-physician services such as ambulance, physical therapy and durable
medical equipment. The acronym "HCPCS" stands for the HCFA/CMS Common Procedure
Coding System.
(3)
"Managed Care Organization" means TennCare program HMO or TennCare Partners
program BHO that pays for, or reimburses for, the costs of health care
expenses.
(4) "Provider" means any
person, partnership, association, corporation or other facility or institution
that renders or causes to be rendered health care or professional services to
TennCare program enrollees or TennCare Partners program enrollees, and
officers, employees or agents of any of the above acting in the course and
scope of their employment.
(5)
"HCFA or CMS" means the Centers for Medicare & Medicaid Services, formerly
known as the Health Care Financing Administration of the U.S. Department of
Health and Human Services.
Authority: T.C.A. §§ 56-32-218(a),
71-5-191, and Public Acts of2001,
Chapter 209, § 1.
