| A |
|
| AA |
Alcohol Anonymous |
| ACD (C) |
Automatic Call Distribution (Center) |
| ADA |
Americans with Disabilities Act |
| Advocate |
A person who works to help you receive proper care |
| ADMIN |
Administrative |
| AFDC |
Aid to Families with Dependent Children
|
| AIDS
|
Acquired Immune Deficiency Syndrome |
| AMA |
Against Medical Advice |
| AOPC |
Administrative Office Pennsylvania Courts |
| APD |
Advanced Planning Document |
| ARD |
Accelerated Rehabilitation Decision
|
| ASAM |
American Society of Addiction Medicine |
| ASCII |
American Standard Code for Information Interchange |
| ASP |
After School Program |
|
B
|
|
| BCABD |
Bureau of Contract Administration and Business Development |
| BDAP |
Bureau of Drug and Alcohol Programs |
| BDAPCIS |
Bureau of Drug and Alcohol Programs Client Information System
|
| BEC |
Basic Education Circular |
| Behavioral Health |
Mental health or alcohol and other drug illness or diseases |
|
Behavioral Health Plan
|
The part of HealthChoices that takes care of your behavioral
health (mental health or alcohol and other drug illnesses) needs. |
| BHEF |
Behavioral Health Encounter File |
| BH-MCO |
Behavioral Health Managed Care Organization |
| BHRS |
Behavioral Health Rehabilitation Services for Children and
Adolescents |
| BNDD |
Bureau of Narcotic Drugs and Devices |
| BSC |
Behavioral Specialist Consultant |
| BSU |
Base Service Unit C&Y Children and Youth |
|
C
|
|
| C&Y |
Children and Youth |
| CA |
Clinical Associate |
| CABHC |
Capital Area Behavioral Health Collaborative, Inc. |
| CAO
|
County Assistance Office |
| CASSP |
Child and Adolescent Service System Program |
| CAU |
County Administrative Unit |
| CBHNP |
Community Behavioral HealthCare Network of Pennsylvania |
| CCM |
Clinical Care Manager |
| CCRS |
Consolidated Community Reporting System |
| CCYA |
County Children and Youth Agency |
| CFO |
Chief Financial Officer |
| CFR |
Code of Federal Regulations |
| C/FST |
Consumer/Family Satisfaction Team |
| CHADD |
Children with Attention Deficit Disorders |
| CI |
Crisis Intervention |
| CIS |
Client Information Specialist |
| CISC |
Children and Adolescents in Substitute Care |
| Clozapine, clozaril |
Medication used to treat people who have Schizophrenia |
| CLIA |
Clinical Laboratory Improvement Amendment |
| CMS |
Centers for Medicare and Medicaid Services |
| COB |
Coordination of Benefits |
| Community |
A region, city or town where people reside. Community also
refers to non-institutional programs within a region, city or town. |
| Complaint |
A written or verbal expression of unhappiness or concern with
CBHNP or a Provider. A complaint is a way of addressing your concerns. |
| Consumer |
Any one who uses a mental health or alcohol and other drug
treatment services. |
| CQI |
Continuous Quality Improvement |
| CRD/LIC |
Credentials/License |
| CRCS |
Capitation Rate Calculation Sheet |
| CRF |
Consumer Registry File |
| Crisis |
A health problem or injury that cannot wait. It has to be
treated quickly. CBHNP can help you get an appointment within one hour. |
| Criteria |
Information used to decide what services you need to treat
your condition. |
| CRNP |
Certified Registered Nurse Practitioner |
| CRR |
Community Residential Rehabilitation |
| CRR-HH |
Community Residential Rehabilitation - Host Home |
| CSI |
Consumer Satisfaction Instruments |
| CSP |
Community Support Program |
| CST |
Consumer Satisfaction Team |
|
D
|
|
| DAP |
Disability Advocacy Program |
| D&A |
Drug and Alcohol |
| DEA |
Drug Enforcement Agency |
| DHHS |
U.S. Department of Health and Human Services |
| DME |
Durable Medical Equipment |
| DMIRS |
Data Management and Information Retrieval System |
| DOH |
Department of Health |
| DPW |
Department of Public Welfare |
| DSH |
Disproportionate Share |
| DSM-IV |
Diagnostic and Statistical Manual |
| DUR |
Drug Utilization Review |
|
E
|
|
| ECC |
Electronic Claims Capture |
| ECM |
Electronic Claims Management |
| EIN |
Employee Identification Number |
| EMC |
Electronic Media Claims |
| Emergency |
A life-threatening situation where you or another person
thinks you need help right away so that you or someone else doesn't get hurt |
| EPSDT |
Early and Periodic Screening, Diagnosis and Treatment |
| EQRO |
External Quality Review Organization |
| ER |
Emergency Room |
| ERISA |
Employee Retirement Income Security Act, 1974 |
| Evaluation |
A series of tests and studies that help
the doctor determine what treatment is best for you |
| EVS |
Eligibility Verification System |
|
F
|
|
| FA
|
Fiscal Agent
|
| FBMHS |
Family Based Mental Health Services |
| FFS
|
Fee-For-Service |
| FQHC
|
Federally Qualified Health Center
|
| FRR
|
Financial Reporting Requirements
|
| FST |
Family Satisfaction Team |
| FTE
|
Full Time Equivalent |
| FTP
|
File Transfer Process
|
|
G
|
|
| GA
|
General Assistance
|
| GAAP |
Generally Accepted Accounting Principles |
| GME |
Graduate Medical Education |
| Grievance |
A formal procedure to address the denial of, reduction of, or
substitution of a service requested by your Provider. It is put in writing for
further investigation and decision is made within 15 days. (See
description in the handbook for more information about how to use the grievance
process.) |
| GTC |
General Terms and Conditions |
|
H
|
|
| HC |
HealthChoices |
| HCQU |
Health Care Quality Unit |
| HCPCS |
CMS Common Procedure Coding System |
| HC-L/C |
HealthChoices Lehigh/Capital |
| HC-NE
|
HealthChoices NorthEast |
| HC-SE
|
HealthChoices - SouthEast |
| HC-SW
|
HealthChoices - SouthWest
|
| HealthChoices |
Pennsylvania's plan for Medical Assistance services for
eligible residents of the State. |
| HEDIS
|
Health Plan Employer Data and Information Set Standards
|
| HIPAA
|
Health Insurance Portability and Accountability Act
|
| HIO
|
Health Insuring Organizations
|
| HIV/AIDS
|
Human Immune Deficiency Virus/Acquired Immune Deficiency
Syndrome
|
| HMO
|
Health Maintenance Organization
|
|
I
|
|
| IBNR
|
Incurred But Not Reported Claims
|
| ICD
|
International Classification of Diseases
|
| ICF
|
Intermediate Care Facility
|
| ICF/MR
|
Intermediate Care Facilities for Persons With Mental
Retardation
|
| ICM |
Intensive Case Management |
| ID
|
Insurance Department
|
| IDEA |
Individuals with Disabilities Education Act |
| IDT |
Intensive Day Treatment |
| IEAP
|
Independent Enrollment Assistance Program
|
| IFB
|
Invitation for Bid
|
| IMD
|
Institutions For Mental Disease
|
| IOC |
Involuntary Outpatient Commitment |
| IOP |
Intensive Outpatient Program |
| IP |
Inpatient |
| ISPT
|
Individualized Service Plan Team
|
|
J
|
|
| JCAHO
|
Joint Commission on the Accreditation of HealthCare
Organizations
|
| JDC
|
Juvenile Detention Center
|
| JPO
|
Juvenile Probation Office
|
|
L
|
|
| LAAM
|
Levo-Alpha-Acetyl-Methadol
|
| L/C
|
Lehigh/Capital
|
| LOC |
Level Of Care |
| LOS |
Length Of Stay |
| LTC
|
Long Term Care
|
|
M
|
|
| MA
|
Medical Assistance |
| MAID
|
Medical Assistance Identification Number |
| MAMIS
|
Medical Assistance Management Information System
|
| MATP
|
Medical Assistance Transportation Program
|
| MBE
|
Minority Business Enterprise
|
| MBE/WBE
|
Minority Business Enterprise/Women Business Enterprise
|
| MCO
|
Managed Care Organization
|
| Medical Management |
Working with a doctor to talk about what medication, if any
might be right for you, how you take the medication and how you feel when you
take the medication. You are the most important part of managing your
medication. |
| Medical Necessity Criteria |
The rules used by an MCO to decide if the services a Member's
doctor wants them to get are necessary. |
| Member |
A person who is enrolled in HealthChoices and with the
Community Behavioral HealthCare Network of Pennsylvania (CBHNP) to receive
mental health or alcohol and other drug treatment services. |
| Member Services |
The department of a health care management company that helps
Members with questions about services, covered benefits, rules, and complaints. |
| MIS
|
Management Information System
|
| MNC |
Medical Necessity Criteria |
| MR
|
Mental Retardation
|
| MWBEO
|
Minority and Women Business Enterprise Office
|
| MOE
|
Method of Evaluation
|
| MPL
|
Minimum Participating Levels
|
| MT |
Mobile Therapist |
|
N
|
|
| NCQA
|
National Committee for Quality Assurance
|
| NDC
|
National Drug Code
|
| NCE
|
Non-Continuous Eligibility
|
| Network |
The group of individuals, agencies, or facilities who provide
services to CBHNP members. |
| NMP
|
Non-Money Payment
|
|
O
|
|
| OBRA
|
Omnibus Budget Reconciliation Act
|
| OCYF
|
Office of Children, Youth & Families
|
| OIP
|
Other Insurance Paid
|
| OIS
|
Office of Information Systems
|
| OMAP
|
Office of Medical Assistance Programs
|
| OMHSAS
|
Office of Mental Health and Substance Abuse Services
|
| OMR
|
Office of Mental Retardation
|
| OP |
Outpatient |
| ORC
|
Other Related Conditions
|
| OSP
|
Office of Social Programs
|
| OTC
|
Over The Counter
|
| Out of Network |
A Provider of services that is not currently enrolled with
CBHNP. |
|
P
|
|
| PCIS
|
Patient Census Information System
|
| PCP
|
Primary Care Practitioner
|
| PCPC
|
Pennsylvania Client Placement Criteria
|
| PDA
|
Pennsylvania Department of Aging
|
| PH-MCO
|
Physical Health Managed Care Organization
|
| PHP |
Physical Health Plan. |
| Physical Health Plan |
The part of HealthChoices that manages physical health care
for people who are eligible for Medical Assistance. |
| Physical Health MCO (PH-MCO) |
Physical Health Managed Care Organization. The same thing as
your physical health plan. |
| PIHP
|
Prepaid Inpatient Health Plan
|
| PIN
|
Parents Involved Network
|
| PMPM
|
Per Member Per Month
|
| POM
|
Performance Outcome Measures
|
| POMS
|
Performance Outcome Management System
|
| POSNet
|
Pennsylvania Open Systems Network
|
| PPO
|
Preferred Provider Organization
|
| Prescription |
Medication given by a doctor to an individual to treat an
illness. It can also be the form that the doctor uses to write instructions to
a drug store that will fill the prescription. |
| Primary Care Physician |
Your personal doctor who will manage all your health care
needs |
| Providers |
The individuals, agencies, or facilities that provide your
health care services (pharmacy, dental, vision, primary care physician, mental
health, alcohol, and other drug treatment services, etc.) |
| PRTF
|
Psychiatric Residential Treatment Facility
|
|
Q
|
|
| QARI
|
Quality Assurance Reform Initiative
|
| QM
|
Quality Management
|
| QMB
|
Qualified Medicare Beneficiaries
|
| QSF
|
Quarterly Status File
|
| QA |
Quality Assurance |
| Quality Assurance |
The methods CBHNP uses to make sure that the services you
receive provide the best care for your needs. |
|
R
|
|
| RBUC
|
Received But Unpaid Claims
|
| RC |
Resource Coordination |
| RFP
|
Request For Proposal
|
| RHC
|
Rural Health Clinic
|
| RTF
|
Residential Treatment Facility
|
|
S
|
|
| SAP
|
Statutory Accounting Principles
|
| SBP
|
State Blind Pension
|
| SCA
|
Single County Authority
|
| SE
|
Southeast
|
| SERB
|
Socially Economically Restricted Business
|
| SMH
|
State Mental Hospital
|
| SMM
|
State Medicaid Manual
|
| SNF
|
Skilled Nursing Facility
|
| SNU
|
Special Needs Unit
|
| Special needs population |
Anyone involved with HealthChoices needing extra help getting
care, care from a specialist, extra help choosing services they need, or help
with community services. |
| SPR
|
System Performance Review
|
| SSA
|
Social Security Administration
|
| SSI
|
Supplemental Security Income
|
| SSN
|
Social Security Number
|
| STAP |
Summer Therapeutic Activity Program |
| SUR
|
Surveillance and Utilization Review
|
| SURS
|
Surveillance and Utilization Review System
|
| SW
|
Southwest
|
|
T
|
|
| TAG |
Therapeutic Activities Group |
| TANF
|
Temporary Assistance to Needy Families
|
| TPL
|
Third Party Liability
|
| TSS |
Therapeutic Staff Group |
| TSSA |
Therapeutic Staff Group Aide |
| Treatment |
Any care or medication given to you under the direction of a
physician, to treat or cure an illness. |
| Treatment Team |
Meeting with a Member or Members of your treatment team to
discuss your goals, care and progress. |
| TTY
|
Text Telephone Typewriter
|
|
U
|
|
| UM
|
Utilization Management
|
| UM/QM |
Utilization Management/Quality Management
|
| UPIN
|
Unique Physician Identification Number
|
| USC
|
United States Code |
