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Definitions and Acronyms

Date: 10/01/2014

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CPT codes: Current Procedural Terminology (CPT) Codes; billing codes.

Centers for Medicare and Medicaid Services (CMS): U.S. Department of Health and Human Services agency responsible for the Medicare and Medicaid programs.

Districts: Term used in this guide to refer to MN public independent districts, charter schools, tribal schools, state academies, intermediate districts, education districts, special education districts and service cooperatives.

EDRS: Minnesota Department of Education’s Electronic Data Reporting System. Districts report salary cost data through this system and MDE provides the data to DHS for IEP services rates.

Eligibility Verification System (EVS): Online system providers use to verify eligibility information for children enrolled in Minnesota Health Care Programs (MHCP).

Explanation of Benefits (EOB): Document that lists health care benefit payments.

HCPCS codes: Health Care Common Procedure Coding System; billing codes.

ICD codes: International Classification of Diseases codes; “diagnosis codes.”

Individualized Education Program (IEP): Written statement for a child with a disability that is developed, reviewed and revised in a meeting according to CFR 34 300.320 through 300.324 and that must include a statement of the special education and related services and supplementary aids and services to be provided.

Individualized Education Program (IEP) Service: Program name for covered MHCP services provided to children through an IEP or IFSP.

Individualized Family Service Plan (IFSP): Written plan for providing early intervention services, as defined in 34 CFR Part 303 to an infant or toddler with a disability and the family that includes a statement of the specific early intervention services necessary to address the unique needs of the child and family.

MN–ITS (“minutes”): HIPAA-compliant Web-based billing system used to submit electronic MHCP health care claims and other transactions.

Medicaid/Medical Assistance (MA): Means-tested benefit program that provides health care coverage and medical services to low-income children. MA is financed jointly by the state and federal governments and administered by the states. Under broad federal rules, each state establishes a state Medicaid plan that outlines eligibility standards, provider requirements, payment methods and benefit packages tailored to the needs of its citizens.

Medicaid Management Information System (MMIS): Minnesota’s statewide automated eligibility and Medicaid claims payment system.

Medically Necessary or Medical Necessity: Health service that is consistent with the child’s diagnosis and condition and is:

  • • Recognized as the prevailing standard or current practice by the provider’s peer group
  • • Rendered in response to a life-threatening condition or pain; to treat an injury, illness, or infection; to treat a condition that could result in physical or mental disability; to care for a mother and child through the maternity period; to achieve a level of physical or mental function; or,
  • • A preventive health service.
  • MinnesotaCare: Subsidized health care program for Minnesota residents who do not have health insurance. The program is open to Minnesota residents who meet program guidelines.

    Minnesota Department of Education: MDE

    Minnesota Health Care Programs (MHCP): Collective term used to refer to Minnesota’s Medical Assistance and MinnesotaCare programs.

    Modifiers: Two-character codes used in conjunction with the IEP services HCPS codes (T1018 and T1013) to further define the service when billing for services IEP services.

    Minnesota Department of Health: MDH

    Minnesota Department of Human Services: DHS

    Payment Error Rate Measurement (PERM): Federal paid claims audit.

    Provider: An individual, organization, or entity that has an agreement with Minnesota Health Care Programs (MHCP) to provide health services.

    Provider News: Online publication of messages formerly included on the Remittance Advice.

    Remittance Advice (RA): Document issued to providers bi-weekly to report claim activity.

    Service Provider: In this guide, the term used to refer to persons who provide covered IEP services to eligible children, for example, physical therapist, certified occupational therapy assistant, school nurse, etc.

    Surveillance and Integrity Review (SIRS): DHS, Office of the Inspector General unit responsible for identifying and investigating suspected fraud, theft and abuse; authorized to seek monetary recovery, impose administrative sanctions; and, authorized to seek civil or criminal action through the office of Attorney General (AG).

    Tax Equity and Fiscal Responsibility Act (TEFRA): Program available to some disabled children who ordinarily would not be eligible for MA, due to parent income. Applicants must be reviewed by the State Medical Review Team. A parental fee may apply.

    Third-Party Payer: Individual, entity, or program that may be liable to pay all or part of incurred health care costs, including private insurance companies and Medicare.

    UFARS: Minnesota Department of Education’s Uniform Financial Accounting and Reporting Standards system. Districts report transportation cost data and benefits data to this system. MDE provides data from this system to DHS for IEP services transportation rates and the benefits data for other IEP services rates.

    Waiver Services: Programs that have federal approval to expand coverage for items and services not usually covered under MA:

  • • Developmental Disabilities (DD)
  • • Community Alternative Care for Chronically Ill Individuals (CAC)
  • • Community Alternatives for Disabled Individuals (CADI)
  • • Traumatic Brain Injury Waiver (TBI)
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