| AAHP |
American Association of
Health Plans |
| AAPCC |
Adjusted average per capita costs |
| ACR |
Adjusted community rate |
| ALOS |
Actual length of stay (in days) |
| APR |
Average payment rate |
| AWP |
Average wholesale price (pharmacy
drugs) |
| BDPT |
Bed days per thousand |
| CCU |
Cardiac care unit |
| CHAMPUS |
Civilian Health and Medical Program
of the Uniformed Services |
| COB |
Coordination of benefits |
| COBRA |
Consolidated Omnibus Budget Reconciliation
Act |
| CPT |
Current procedural terminology codes |
| DME |
Durable medical equipment |
| DRG |
Diagnosis related group (also see
RBRVS) |
| Dx |
Diagnosis |
| EAP |
Employee Assistance program |
| EOB |
Explanation of benefit |
| EOP |
Explanation of payment |
| EPO |
Exclusive provider organization |
| ER |
Emergency room |
| FDOS |
First date of service |
| FFS |
Fee-for-service |
| FTE |
Full-time equivalents |
| HCFA |
Health Care Financing Administration |
| HMO |
Health maintenance organization |
| HIPCs |
Health insurance purchasing cooperatives |
| IBNR |
Incurred but not reported or received |
| ICD-9-CM |
International Classification of Diseases-9th
Revision - Clinical Modification |
| I/P |
Inpatient |
| IPA |
Independent practice (physician) association |
| JCAHO |
Joint Commission on Accreditation
of Healthcare Organizations |
| LDOS |
Last date of service |
| LOS |
Length of stay (in days) |
| MG |
Medical group |
| NCQA |
National Committee for Quality Assurance |
| NMHCC |
National Managed Health Care Congress |
| OOA |
Out-of-area |
| OON |
Out-of-network |
| O/P |
Outpatient |
| OTC |
Over-the-counter |
| PCP |
Primary care physician |
| PMPM |
Per member per month |
| PN |
Primary network |
| POP |
Percent of premium |
| POS |
Point-of-service |
| PPO |
Preferred provider organization |
| PTMPY |
Per thousand members per year |
| QA |
Quality assurance |
| RBRVS |
Resource-based relative value schedule |
| Rx |
Prescription |
| SNF |
Skilled nursing facility |
| TPA |
Third-party administrator |
| UR |
Utilization review |
