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ANSIAmerican National Standards Institute
ASCAAdministrative Simplification Compliance Act
CCNClaim Control NumberNumber assigned to claims accepted by CEDI to be used to track claims processed by the DME MACs. Also referred to as ICN. Example: 09057850011000
CEDICommon Electronic Data InterchangeElectronic gateway for the exchange of Medicare DME transactions
CMNCertificate of Medical NecessityA certificate that supports the need of a DME item
CMSCenters for Medicare & Medicaid Services
CSIClaim Status InquiryAllows suppliers to access claim status and beneficiary eligibility data. Supported by the individual DME MACs.
CWFCommon Working FileA record containing a beneficiary’s complete entitlement, utilization, history, Medicare Secondary Payer (MSP), and Health Maintenance Organization (HMO) data.
DMEDurable Medical EquipmentMedical equipment used at the patient’s place of residence that contributes to a better quality of life and can be used over an extended period of time
DME MACDurable Medical Equipment Medicare Administrative Contractor
DMEPOSDurable Medical Equipment, Prosthetics, Orthotics, and Supplies
EDIElectronic Data Interchange
EFTElectronic Funds TransferDirect deposit of Medicare payments to the supplier’s bank account. Supported by the individual DME MACs.
EMCElectronic Media Claims
EOBExplanation of BenefitsDetail description of benefits paid for a claim provided to the beneficiary
ERAElectronic Remittance AdviceA detailed electronic report of payments/non-payments made by Medicare provided to the supplier. Also was referred to as an Electronic Remittance Notice (ERN)
HCPCSHealthcare Common Procedure Coding SystemA code used to identify products, supplies, and services. Also referred to as a procedure code
HIPAAHealth Insurance Portability & Accountability ActRequires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
ICNInternal Control NumberAnother term for the Claim Control Number (CCN) returned on the 277CA produced by CEDI. Example: 09057850011000
MACMedicare Administrative Contractor
NCPDPNational Council for Prescription Drug ProgramsA format used by retail pharmacies that transmit DME retail drug claims electronically.
NDCNational Drug CodeThe NDC replaces the HCPCS codes for retail pharmacy drug transactions billed to DME MACs via the NCPDP standard.
NPINational Provider IdentifierUnique identifier assigned by the NPPES to health care providers. Example: 1234567891
NPPESNational Plan & Provider Enumeration SystemEntity who assigns unique identifiers for health care providers and health plans as mandated by HIPAA (NPI)
NSCNational Supplier ClearinghouseEntity who assigns unique numbers that identifies the applicant as a DMEPOS supplier. The unique number is referred to as a PTAN, supplier, or NSC number.
NSVNetwork Service VendorEntity who offers connectivity over a dedicated line to a Medicare contractor including CEDI
PECOSProvider Enrollment , Chain and Ownership SystemPECOS is the Internet-based Medicare enrollment system. For more information visit http://www.cms.gov
PTANProvider Transaction Access NumberUnique supplier number assigned by the NSC. This number is 10 digits and typically ends in a 0001, 0002, 0003, or something similar.
TPTrading PartnerSubmitter who exchanges electronic transactions with CEDI. Also referred to as a submitter or sender.
TP IDTrading Partner IdentifierUnique identifier used by the Trading Partner (Submitter/Sender) assigned by CEDI. Example: B08123456 This will begin with A08, B08, C08, or D08 followed by 6 digits.
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