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Section J Attachment 27 - Glossary
United States Department of Labor
(DOL)
Workers’ Compensation Medical Bill Process (WCMBP)
Attachment 27 –
Glossary Template
December 30, 2013
Office of Workers’ Compensation Programs (OWCP)
Glossary
This document defines the terms, acronyms, and abbreviations used in the Workers’ Compensation Medical Bill Process (WCMBP) acquisition. This includes all sections of the Request for Proposal (RFP), as well as the Acquisition Plan (ACQP), the Cost-Benefit Analysis (CBA), the Quality Assurance Surveillance Plan (QASP), the Source Selection Plan (SSP) The Glossary provides the terms for which abbreviations are used and defines terms where appropriate. Acronyms may not have a definition and terms may not have an acronym.
3M Grouper/Pricer
3M product that provides both Medicare and non-Medicare DRG grouping and pricing for inpatient and outpatient claims data for providers, payers, vendors, as well as state and federal agencies
Acceptance Testing
Testing performed by the Government to ensure deliverable is in conformance with requests
Accepted Condition
Workers are entitled to coverage by virtue of being accepted by the Government as having a work-related illness or injury. This accepted condition is the only condition for which services shall be reimbursed
Active Case
A synonym for an open case
Ad Hoc Reports
Formatted output created as needed by an end user. Ad hoc reports allow users to define both the selection criteria for collections to include in a report and the information which will appear in the report
Adjudication
Determination of whether a bill is reimbursable
| Advanced Registered Nurse Practitioner |
| ARNP |
| Affiliated Computer Services |
| ACS |
| Ambulatory Surgery Codes |
| ASC |
| American Academy of Professional Coders |
| AAPC |
| See also CPC |
| American Health Information Management Association |
| AHIMA |
| See also CCS |
| American Medical Association |
| AMA |
| Associate of Science in Nursing |
| ASN |
Audit Trail
A sequence of recorded events from which a history of what actions were performed, at what time, and by what individual(s) may be reconstructed. The actions are transactions, such as generating, updating, calculating or deleting
| Automated Clearing House |
| ACH |
| Automated Support Program |
| ASP |
| Average Speed of Answer |
| ASA |
| Average Wholesale Price |
| AWP |
Basic Document Identifying Information
The minimum information required to process and/or store a document such as document type, claimant SSN or a unique identifier to ensure uniqueness across multiple documents of the same type for a given claimant
Batch
To group together the same types of documents for processing
Benefit Overpayment
Benefit payments made to a claimant over and above that to which the claimant was entitled
Bidder
A vendor that bids on the RFP See also Offeror
| Black Lung |
| Black Lung |
| One of the OWCP WCMBP benefit programs |
| Black Lung Accounting System |
| BLAS |
| Black Lung Benefits Act |
| BLBA |
| A Federal statute authorizing one of the WCMBP benefit programs |
Boilerplate
A pre-defined text block
| Business Continuity Plan |
| BCP |
| The documentation of a predetermined set of instructions or procedures that describes how an organization’s business functions will be sustained during and after a significant disruption |
Case
A claim and its associated documentation
Categorized Staff
Certain staff that perform similar job functions
| Centers for Medicare & Medicaid Services |
| CMS |
| Certificate of Medical Necessity |
| CMN |
| Certified Registered Nurse Anesthetist |
| CRNA |
| Claim Number |
| CN |
| A unique number used to identify a claim. For Energy and Black Lung, the claim number is the SSN. For FECA, the claim number is a unique number not related to SSN |
Claimant
A person, such as a worker or survivor(s), with an accepted condition approved by DCMWC, DEEOIC, or DFEC and an associated case number
| Claimant Query System |
| CQS |
Closed Case
A closed case is one in which there is no additional Adjudication or Post-Adjudication required
| CMS Professional Billing Form |
| CMS-1500 |
| Professional Billing Form See also HCFA-1500 or OWCP-1500 |
Compensable Condition
Accepted condition
Compensation
The money the Department of Labor pays to or on behalf of a covered employee or eligible survivor
| Computer-Based Training |
| CBT |
| Computer Security Handbook |
| CSH |
| Computer-Telephone Integration |
| CTI |
| Concept of Operations |
| CONOPS |
Consequential Injury
Any injury, illness, impairment, or disability sustained by a covered employee as a result of a covered illness or occupational illness under the act that authorizes benefits
| Consultant Determination Claim Form |
| CM-978 |
| Contingency Plan |
| CP |
| Management policy and procedures designed to maintain or restore business operations, including computer operations, possibly at an alternate location, in the event of emergencies, system failures, or disaster |
| Contracting Officer's Representative |
| COR |
| Contract Line Item Number |
| CLIN |
Contractor
The vendor bidding on this procurement
| Correct Coding Initiative |
| CCI |
| Cost-Benefit Analysis |
| CBA |
| Critical Design Review |
| CDR |
| Current Procedural Terminology |
| CPT |
| Medical Codes |
Decision
An index category that contains all formal decisions (both preliminary and final) as well as written acceptances of claims
| Department of Energy |
| DOE |
| Includes the predecessor agencies of the DOE, e.g., the Manhattan Engineering District and the Atomic Energy Commission |
Diagnosis Codes
ICD-9 codes published by the CDC
| Diagnosis Related Group |
| DRG |
| Medical Codes |
Diagnosis Table
Assigns a value to each billed diagnosis (Covered and Uncovered)
Direct Cost
Cost that is identified specifically with a particular final cost objective, which can be labor or non-labor
| District Medical Advisor |
| DMA |
| District Office Troubleshooter |
| DOT |
| Division of Administration and Operations |
| DAO |
| Division of Coal Mine Workers' Compensation |
| DCMWC |
| Division of Energy Employees Occupational Illness Compensation |
| DEEOIC |
| Division of Federal Employees Compensation |
| DFEC |
Document
A file containing information such as a report, letter, brochure, memo, or form. A document may be based on a Document Template
| Document Control Number |
| DCN |
| A unique number used to identify and track a document |
Document Template
A file that acts as a pattern or blueprint for creating another document See also Template
| Drug Enforcement Agency |
| DEA |
| Durable Medical Equipment |
| DME |
| Electronic Certification System |
| ECS |
| Electronic Data Interchange |
| EDI |
| Electronic Funds Transfer |
| EFT |
Eligible
| Energy |
| DEEOIC |
| One of the WCMBP benefit programs |
| Energy Employees Occupational Illness Compensation |
| EEOIC |
| Energy Employees Occupational Illness Compensation Program |
| EEOICP |
| Energy Employees Occupational Illness Compensation Program Act |
| EEOICPA |
| A Federal statute authorizing one of the WCMBP benefit programs enacted in 2000, as amended, 42 USC. § 7384 et seq |
| Explanation of Benefits |
| EOB |
| Federal Acquisition Regulations |
| FAR |
| Federal Employees’ Compensation Act |
| FECA |
| A Federal statute authorizing one of the WCMBP benefit programs |
| Federal Financial Management Improvement Act |
| FFMIA |
| Federal Identification Code |
| FIC |
| A numeric code assigned to each agency of the Federal Government to ensure uniform identification of all federal government agencies |
| Federal Information System Controls Audit Manual |
| FISCAM |
| Federal Information Security Management Act |
| FISMA |
| Federal Information Processing Standards |
| FIPS |
| A set of Government standards document for information processing |
| Federal Information Processing Standards Code |
| FIPS Code |
| A standardized set of numeric or alphabetic codes issued by the NIST to ensure uniform identification of geographic entities through all federal government agencies |
| Federal Information Processing Standards Publication |
| FIPS PUB |
| Financial Systems Integration Office |
| FSIO |
Flag
An indicator on a record to denote that certain activity may or may not occur, depending upon whether the indicator is set or not set, on or not on
Foreign Bills
Bills for services provided in a foreign country
Forms
Approved Government documents used to obtain information from claimants, providers, etc
Formulary File
List of drugs that are payable by the Black Lung program. (Please note that the term applies ONLY to Black Lung)
| Fraud and Abuse Detection |
| FAD |
| Freedom of Information Act |
| FOIA |
| The law that provides for public access to documents maintained by the government, and it requires the government to release those documents upon request, unless the requests or documents fall within one of nine exceptions listed in the law. The act requires the publication of indexes of specified agency documents and records; provides time limitations for responding to requests; establishes a system of penalties for non-compliance with the time limitations; requires identification of persons responsible for granting or denying requests; provides for court review of denials; including classified materials; and provides for the levying of charges for searching and copying requested materials |
| Frequently Asked Questions |
| FAQ |
| General Services Administration |
| GSA |
| Generic Code Nomenclature |
| GCN |
| Geographic Adjustment Factor |
| GAF |
Government
The Department of Labor, the DOL Employee Standards Administration’s Office of Workers’ Compensation Programs or any of its subsidiary organizations
| Government Acceptance Testing |
| GAT |
| Government Accountability Office |
| GAO |
| Government-Furnished Equipment |
| GFE |
| Government-Furnished Information |
| GFI |
| HCFA Billing Form 1500 |
| HCFA-1500 |
| Professional Billing Form See also CMS-1500 or OWCP-1500 |
| Health and Human Services |
| HHS |
| Health Care Financing Administration |
| HCFA |
| The agency now know as Centers for Medicare and Medicaid Services |
| Health Insurance Portability and Accountability Act |
| HIPAA |
| Healthcare Common Procedure Coding System |
| HCPCS |
| A medical coding system |
Homegrown Codes
Procedure or service codes devised by the OWCP Programs
Impairment
A term that refers to physical impairment as a result of a reported occupational illness. Impairment is claimed on a Form EE-10 or other documentation
| Independent Medical Physical Assessment Report |
| IMPAR |
Indexing
For FECA only: the generation and assignment of codes to images, developed using FECA-specific document processing rules, for the purpose of categorizing, identifying and routing specific document types
| Information Technology |
| IT |
| Inpatient Prospective Payment System |
| IPPS |
| Integrated Federal Employees' Compensation System |
| iFECS |
| A case management system for FECA claims |
Integration Testing
Software development process which program units are combined and tested as groups in multiple ways. In this context, a unit is defined as the smallest testable part of an application. Integration testing can expose problems with the interfaces among program components before trouble occurs in real-world program execution
| Interactive Voice Response |
| IVR |
| Interactive Voice Response System |
| IVRS |
| Interconnection Security Agreement |
| ISA |
| Internal Revenue Service |
| IRS |
| International Classification of Diseases |
| ICD |
| A medical coding system |
| International Classification of Diseases, version 10 |
| ICD-10 |
| The proposed follow-on version of the ICD medical coding system |
| International Classification of Diseases, version 9 |
| IDC-9 |
| The current version of the ICD medical coding system |
| International Statistical Classification of Diseases and Related Health Problems |
| ICD-9-CM |
| The current version of the ICD clinical modification medical coding system |
Key Personnel
Individuals identified by name in the Contractor's proposal for designated high-level positions considered critical to the successful execution of contract requirements. Proposed staff should meet the Government’s qualifications and experience requirements, and be devoted to the contract as bid. The Contracting Officer shall be notified of substitutions after award and concur wit any change(s)
Landing Zone
A staging area used to place and retrieve electronic files
| Medical Authorization Form |
| CA-16 |
| Medical Benefits Identification Card |
| MBIC |
| Card used to indicate that a claimant is covered by the Energy or Black Lung program |
| Memorandum of Understanding |
| MOU |
| Metropolitan Statistical Area |
| MSA |
| Minimum Background Investigation |
| MBI |
| National Agency Check Investigation |
| NACI |
| National Council for Prescription Drug Programs |
| NCPDP |
| National Council Licensure Examination |
| NCLEX |
| A license examination for Registered Nurses |
| National Council of State Boards of Nursing |
| NCSBN |
| National Drug Codes |
| NDC |
| Standardized medication codes |
| National Institute for Occupational Safety and Health |
| NIOSH |
| National Institute of Standards and Technology |
| NIST |
| National Institute of Standards and Technology |
| NIST |
| National Provider Identifier |
| NPI |
| National Provider System |
| NPS |
Non-Functional Requirements
The customer’s documented expectations for system usability and reliability, as well as any system characteristics or contractor deliverables associated with system documentation, maintenance, or user support
Non-Scannables
Videotapes, X-rays, photographs, pictures, and other physical evidence associated with DFEC cases, submitted to the Central Mailroom
Non-Standard Documents
Non-bar coded, non-standard DOL forms that contain handwritten or typed basic document identifying information
| North American Industry Classification System Code |
| NAICS |
| A six-digit code used to classify the employer’s business and to determine the tax rate assigned new employers. See also SIC |
Offeror
A vendor that submits a proposal against the RFP. See also Bidder, Vendor
| Office of Management and Budget |
| OMB |
| Office of Procurement Services |
| OPS |
| Office of the Inspector General |
| OIG |
| Office of Workers' Compensation Programs |
| OWCP |
Offset
An amount of money which is to be subtracted from any benefit awarded, based on a claimant’s receipt of a monetary amount for a tort suit or state workers’ compensation claim
| Other Direct Costs |
| ODC |
| The specific non-labor cost types listed in Section B that are incurred by the contractor and passed directly to the Government for payment |
| Outpatient Prospective Payment System |
| OPPS |
| OWCP Billing Form 1500 |
| OWCP-1500 |
| Professional Billing Form See also CMS-1500 or HCFA-1500 |
| OWCP Claimant Medical Reimbursement Request Form |
| OWCP-915 |
| Claimant Medical Reimbursement Request for drug and treatment |
| OWCP Claimant Travel Reimbursement Request Form |
| OWCP-957 |
| Claimant Travel Reimbursement Request |
Parallel Testing
Testing of the same test data on the legacy and new WCMBP for the purpose of ensuring the new WCMBP outputs the same results as the legacy WCMBP
| Period of Performance |
| POP |
| Personally Identifiable Information |
| PII |
| Information that can be used to distinguish or trace an individual’s identity, such as their name, social security number, biometric records, etc., alone or when combined with other personal or identifying information, which is linked or linkable to a specific individual, such as date and place of birth, mother’s maiden name, etc |
| Physician’s Desk Reference |
| PDR |
| Plan of Action & Milestones |
| POA&M |
| Point of Contact |
| POC |
| A person at an organization or someone who has a relationship with an organization. For example, a Point of Contact can be a particular DOL staff member |
| Preferred Provider Organization |
| PPO |
| A health care organization composed of physicians, hospitals, or other providers which provides health care services at a reduced fee |
| Preliminary Design Review |
| PDR |
Privacy Act
The statute governing a private citizen’s right to confidentiality of personal information, including financial and medical history, in records filed in a system of records under the individual’s own name. This law sets forth the government’s responsibility to properly maintain and restrict access to these records
Procedure Codes
Codes belonging to various coding schemas that describe medical services
| Procurement Review Board |
| PRB |
Production Environment
The environment in which the actual business operations are conducted
| Program Management Office |
| PMO |
| Project Management Institute |
| PMI |
| An organization that certifies Project Management Professionals |
| Project Management Plan |
| PMP |
| A plan for the management of a project |
| Project Management Professional |
| PMP |
| Professional certification in Project Management from PMI |
| Prompt Payment Act |
| PPA |
| The Federal law that ensures that federal agencies pay vendors in a timely manner |
| Prospective Payment System |
| PPS |
| Medicare |
Provider
A medical professional or healthcare organization that provides medical services to Government claimants
| Quality Assurance Surveillance Plan |
| QASP |
| Ronald Reagan National Airport |
| DCA |
Recoupment
The recovery of money from a provider, for payments made incorrectly to the provider or the withholding of future payment to a provider to offset previous overpayments
Redact
To edit confidential, irrelevant, or sensitive information out of a document, usually by blacking it out
Regression Testing
Retesting of a previously tested program following modification to ensure that faults have not been introduced or uncovered as a result of the changes made
Rehab
Rehabilitation
| Relative Value Unit |
| RVU |
| Medicare |
| Requirements Traceability Matrix |
| RTM |
| Resource-Based Relative Value Scale |
| RBRVS |
| Pricing methodology |
Retesting
A second or repeated test performed after correcting a deficiency discovered during a previous test
| Return to Provider |
| RTP |
| The process of returning documents to a provider (or claimant, for claimant-submitted documents) due to missing or invalid information or some other reason that renders the document unable to be processed according to Government standards |
Returned Mail
Mail sent out by DOL that has been returned to DOL by the US Post Office because they could not be delivered
RFP Library
A repository of information available to all vendors that bid on the RFP
Rollback
A feature of transaction processing systems that enables databases to reverse any changes
| Simple Object Access Protocol |
| SOAP |
| Social Security Number |
| SSN |
Software Functional Requirements
Functional requirements that pertain specifically to the software component of a system. They document the customer’s expectations for how the software is expected to behave, either in response to direct user input, input from one or more interfaced systems, or in a variety of standard and non-standard operating scenarios
| Source Selection Plan |
| SSP |
| Standard Carrier Reimbursement Form |
| NALC-200 |
| Standard Industrial Classification Code |
| SIC |
| A coding system developed to classify work establishments by the type of activity they perform. See also NAICS |
| Standard Operating Procedure |
| SOP |
| Statement of Accepted Fact |
| SOAF |
| Subject Matter Expert |
| SME |
Sub-Process
A subset of the work tasks associated with a Process. See also Process
System Testing
The testing of a complete system prior to delivery. The purpose of system testing is to identify defects that will only surface when a complete system is assembled. That is, defects that cannot be attributed to individual components or the interaction between two components. System testing includes testing of performance, security, configuration sensitivity, startup, and recovery from failure modes
| System Integration Testing |
| SIT |
| Tagged Image File Format |
| TIFF |
Telephone Alert
The system notifies a user of a pending call that requires action by the user
Template
A file that establishes or serves as a pattern for another. See also Document Template
The Department
United States Department of Labor
| Therapeutic Class |
| TC |
| Medical Codes |
Timely
When the term is applied to documents, it indicates that the document was returned to DOL within the time allowed by Law or as stated on the document. When the term is applied to a major task completion, it indicates that the task was completed within the time specified by state or federal guidelines or established policy or procedure issued by DOL
Transaction Record
From an Information Technology point of view, a transaction record is the history of an information exchange and related work (such as database updating) that is treated as a unit for the purposes of satisfying a request and for ensuring database integrity
| Treatment Suites |
| TS |
| The Government’s Treatment Suites are set of diagnosis-driven algorithms that determine authorization requirements and the procedures, drugs, hospitalization, DME, and all other services that are payable for accepted condition(s) |
| Unified Energy Case Management System |
| UECMS |
| A case management system used for Energy claims |
| Uninterruptible Power Supply |
| UPS |
Unique Identifying Value
A synonym for Key. A unique identifying value is a database entry that is used to identify one particular record
| United States Postal Service |
| USPS |
| Universal billing form |
| UB-04 |
| A form used by hospitals – inpatient and outpatient (formerly UB-92) |
| Un-reviewed |
| UN |
| A case status |
Untimely
When the term is applied to documents, it indicates that the document was not returned to DOL within the time allowed by Law or as stated on the document. When the term is applied to a major task completion, it indicates that the task was not completed within the time specified by state or federal guidelines or established policy or procedure issued by DOL
User
A person that uses a data processing system
Vendor
A company or individual that offers products or services
Vendor Library
A repository of information that is accessible to the bidder that is awarded the contract
Volume Testing
Non-functional testing of a software application for a certain volume of data. This volume can in generic terms be the database size or it could also be the size of interface files that are the subject of volume testing
| Wage Hour Division |
| WHD |
| A division of the US DOL |
Web Browser
A software application that operates as the user’s primary method for accessing sites on the World Wide Web, using the Internet as the communications network. Two examples of Web Browsers are Microsoft’s Internet Explorer series and the Netscape Navigator series
Workday
A single work-shift whether or not it occurred on more than one calendar day
| Workers’ Compensation Medical Bill Process |
| WCMBP |
Worst-case assumption
A term used to describe a type of assumption for certain dose reconstructions. It assigns the highest reasonably possible value to a radiation dose of a covered employee based on reliable science, documented experience, and relevant data