Current through Bulletin 2024-06, March 15, 2024
Terms used in this rule are defined in Section
31A-1-301. Additional
terms are defined as follows:
(1)
"CMS" means the Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services.
(2) "Electronic Data Interchange Standard"
means:
(a) the ASC X12N standard format
developed by the Accredited Standards Committee X12N Insurance Subcommittee of
the American National Standards Institute and the ASC X12N implementation
guides as modified by the UHIN Standards Committee; and
(b) any other standard developed by the UHIN
Standards Committee at the request of the commissioner and incorporated by the
commissioner in rule.
(3)
"HIPAA" means the federal Health Insurance Portability and Accountability
Act.
(4) "HPID" means Health Plan
Identifier, which is the national unique health plan identifier assigned to
identify each individual health plan.
(5) "NUBC" means the National Uniform Billing
Committee.
(6) "NUCC" means the
National Uniform Claim Committee.
(7) "Payer" means an insurer or third-party
administrator that pays, or reimburses for, the costs of health care.
(8) "Provider" means any person, partnership,
association, corporation, or other facility or institution that renders health
care or professional services, and any officer, employee, or agent of any of
the above acting in the course and scope of their employment.
(9) "UHIN Standards Committee" means the
Standards Committee of the Utah Health Information Network.
(10) Uniform Claim Codes are defined as:
(a) "ASA codes" means the codes contained in
the ASA Relative Value Guide maintained by the American Society of
Anesthesiologists to describe anesthesia services and related
modifiers.
(b) "CDT codes" means
the Current Dental Terminology published by the American Dental
Association.
(c) "CPT codes" means
the Current Procedural Terminology published by the American Medical
Association.
(d) "DRG codes" means
Diagnosis Related Group codes, which are universal grouping codes used to
clarify the type of inpatient care received, and, when used with a diagnosis
code and the length of the inpatient stay, to determine payment and
reimbursement for claims.
(e)
"HCPCS" means Healthcare Common Procedure Coding System, a coding system that
describes products, supplies, procedures, and health professional services,
including:
(i) "HCPCS Level 1 codes," which
are CPT codes and modifiers for professional services and procedures;
and
(ii) "HCPCS Level 2 codes,"
which are national alphanumeric codes and modifiers for health care products
and supplies, as well as some codes for professional services not included in
CPT codes.
(f) "ICD-CM
codes" means the diagnosis and procedure codes in the International
Classification of Diseases, Clinical Modifications published by the U.S.
Department of Health and Human Services.
(g) "NDC" means the National Drug Codes of
the Food and Drug Administration.
(h) "UB-04 Rate Codes" means the code
structure and instructions established for use by the NUBC.
(12) Uniform Claim Forms are defined as:
(a) "UB-04" means the health insurance claim
form maintained by NUBC for use by institutional care providers.
(b) "Form CMS 1500" means the health
insurance claim form maintained by NUCC for use by health care
providers.
(c) "J400" means the
uniform dental claim form approved by the American Dental Association for use
by dentists.
(d) "NCPDP" means the
National Council for Prescription Drug Program's Claim Form or its electronic
counterpart.
