List of Acronyms

BWC: Ohio Bureau of Workers' Compensation

COB: Coordination of Benefits

CPT: Current Procedural Terminology

DME: Durable Medical Equipment

DRGs: Diagnosis Related Groups

ECF: Extended Care Facility

EOB: Explanation of Benefits

EPSDT: Early and Periodic Screenings, Diagnosis and Treatment

ERISA: Employee Retirement Income Security Act of 1974

HCFA 1500: Health Care Finance Administration form 1500

HHS: The Department of Health and Human Services

HMO: Health Mainatenance Organization

HPP: Health Partnership Program

IBNR: Incurred But Not Reported

ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification

MCE: Medical Care Evaluation Studies

MLR: Medical Loss Ratio

NCQA: National Committee for Quality Assurance

PCP: Primary Care Provider

PHO: Physician-Hospital Organization

PPO: Preferred Provider Organization

PSRO: Professional Standards Review Organization

QA: Quality Assurance

QHP: Qualified Health Plan

R.N.s: Registered Nurses

TPA: Third Party Administrator

UB-92: Uniform Bill 1992

UCR: Usual, Customary and Reasonable

UR: Utilization Review

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