Acronyms & Abbreviations

AMA American Medical Association
ASO Administrative Services Only
AWP Average Wholesale Price
CDT Common Dental Terminology
CMS Center for Medicare & Medicaid Services
COB Coordination of Benefits
COBRA Consolidated Omnibus Budget Reconciliation Act
CPT Physician’s Current Procedural Terminology
CRNA Certified Registered Nurse Anesthetist
CYM Calendar Year Max
DME Durable Medical Equipment
DOB Date of Birth
DOI Date of Injury
DOS Date of Service
EAP Employee Assistance Program
EOB Explanation of Benefits
ERISA Employee Retirement Income Security Act of 1974
FSA Flexible Spending Account (“125 Plan”)
HCPCS HCFA Common Procedural Coding System
HDHP High Deductible Health Plan
HHS Department of Health and Human Services
HIPAA Health Insurance Accountability and Portability Act
HITECH Health Information Technology for Economic and Clinical Health Act
HSA Healthcare Savings account
IBNR Incurred But Not Reported
ICD-9-CM International Classification of Diseases, 9th Edition (Clinical Modification)
LTM Lifetime Maximum
MVA Motor Vehicle Accident
NDC National Drug Code – unique # for every prescription drug available
NDC National Data Corporation (Claim EDI warehouse)
OON Out of Network
OOP Out of Pocket expenses
OTC Over the Counter
PMPM Per Member per Month
PMPY Per Member per Year
POS Point of Service or Place of Service
PPACA Patient Protection and Affordable Care Act (“Obamacare”)
PPO Preferred Provider Organization
PQB Primary Qualified Beneficiary
SPD Summary Plan Description
STD Short Term Disability
TPA Third Party Administration
YTD Year to Date