Edit 1: readability and spelling (2025-08-20)
 Edit 2: factual updates (2025-08-20)

Acronym | Expansion | Notes

AAC | Actual Acquisition Cost | How much the pharmacy paid to get the drug

ACH | Automated Clearing House | Network used for routine fund transfers like paychecks or monthly debits

ACO | Accountable Care Organization

AHH | American Health Holding | A medical benefit manager currently owned by Aetna which is in turn owned by CVS (2025)

AMA | American Medical Association

API | Application Programming Interface

ARRA | American Recovery and Reinvestment Act of 2009

AWP | Average Wholesale Price | A benchmark for wholesale pricing but not related to market price for the consumer (generally Rx)

BAA | Business Associate Agreement | relationship between HIPAA-covered entities and business associates

CAH | Critical Access Hospital

CAHPS | Consumer Assessment of Healthcare Providers and Systems

CCD | Continuity of Care Document

CCN | CMS Certification Number

CDH | Consumer Driven Health | A plan that allows utilizing pretax money to cover expenses Similar to HSA or HRA

CDS | Clinical Decision Support

CDT | Certified Dental Technicians | Defines a code set for dental procedures

CEHRT | Certified Electronic Health Record Technology

CFR | Code of Federal Regulations

CHC | Change HealthCare | Owned by UnitedHealthcare Group

CHIP | Children's Health Insurance Program

CHIPRA | Children's Health Insurance Program Reauthorization Act of 2009

CMS | Centers for Medicare & Medicaid Services

COB | Coordination of Benefits | Which plan pays first when multiple plans cover it

CPOE | Computerized Provider Order Entry

CPT | Current Procedural Terminology | A procedure code set defined by the AMA

CQM | Clinical Quality Measure

CX | Customer Experience

DBA | Doing Business As | When a company brands itself differently in different locations especially common when one company buys another

DED | Deductible

DME | Durable Medical Equipment | e.g. a wheelchair is DME but bandages are not

EDI | Electronic Data Interchange

EHR | Electronic Health Record

EIN | Employer Identificaion Number | A tax ID issued by the IRS

EME | Eligible Medical Expense

EOB | Explanation of Benefits

EP | Eligible Professional

EPO | Exclusive Provider Organization

EPR | Electronic Patient Record

ESI | Express Scripts | Used to be Express Scripts Inc before Cigna bought them

FACA | Federal Advisory Committee Act

FDA | Food and Drug Administration

FFP | Federal Financial Participation

FFY | Federal Fiscal Year

FFS | Fee-For-Service

FQHC | Federally Qualified Health Center

FTE | Full-Time Equivalent

FY | Fiscal Year

GCP | Good Clinical Practice

HCA | Health Care Authority

HCFA | Health Care Financing Administration | Now CMS, this billing format is for individual practitioners

HCPC | Health and Care Professions Council | Formerly HPC - Manages/defines a code set for medical procedures etc

HEDIS | Healthcare Effectiveness Data and Information Set

HHS | Department of Health and Human Services

HIE | Health Information Exchange

HIT | Health Information Technology

HITPC | Health Information Technology Policy Committee

HIPAA | Health Insurance Portability and Accountability Act of 1996

HITECH | Health Information Technology for Economic and Clinical Health Act

HMO | Health Maintenance Organization

HMS | Healthcare Management Systems | HMS Holdings Corp

HOS | Health Outcomes Survey

HPC | Health and Care Professions Council | Now HCPC - Manages/defines a commonly used code set

HPSA | Health Professional Shortage Area

HRA | Health Reimbursement Account

HRSA | Health Resource and Services Administration

IAPD | Implementation Advance Planning Document

IBNR | Incurred But Not Reported

ICD | International Classification of Diseases | Diagnosis codes defined by WHO

ICR | Information Collection Requirement

ID | Identifier

IHS | Indian Health Service

IPA | Independent Practice Association

IRB | Institutional Review Board | Groups intended to provide ethics and safety oversight in clincal trials

IRN | Integrated Repricing Network | Optum related to claims

IRR | Insight Record Review | Optum app related to claims

IRS | Internal Revenue Service

IS | Information Services

IT | Information Technology

LOB | Line of Business

LOINC | Logical Observation Identifiers and Codes System | standard for identifying health measurements

MA | Medicare Advantage

MAC | Maximum Allowable Cost | Max the plan will pay (generally Rx)

MAC | Medicare Administrative Contractor

MAO | Medicare Advantage Organization

MCO | Managed Care Organization

MI | Medical Integrator | This term is sometimes used to refer to groups that coordinate data

MIPS | Merit-based Incentive Payment System | Medicare-related

MITA | Medicaid Information Technology Architecture

MMIS | Medicaid Management Information Systems

MOOP | Maximum Out of Pocket

MSA | Medical Savings Account

MSP | Medicare Secondary Payer

NAAC | Net Average Allowable Cost | CEHRT-related

NCPDP | National Council for Prescription Drug Programs

NCQA | National Committee for Quality Assurance

NCVHS | National Committee on Vital and Health Statistics

NDC | National Drug Code

NPI | National Provider Identifier

NPRM | Notice of Proposed Rulemaking

OE | Open ENrollment

ONC | Office of the National Coordinator for Health Information Technology

OOP | Out of Pocket

PAHP | Prepaid Ambulatory Health Plan

PAPD | Planning Advance Planning Document

PCP | Primary Care Provider

PECOS | Provider Enrollment Chain and Ownership System

PFFS | Private Fee-For-Service

PHO | Physician Hospital Organization

PHR | Personal Health Record

PHS | Public Health Service

PHSA | Public Health Service Act

PI | Prinipal Investigator | Lead researcher in a clinical trial

PIHP | Prepaid Inpatient Health Plan

POS | Place of Service

PPO | Preferred Provider Organization

PQRS | Physician Quality Reporting System

PSO | Provider Sponsored Organization

QLE | Qualifying Life Event | Events that allow you to make changes to your health insurance outside the usual timeframe of the contract

QPP | Quality Payment Program | of Medicare

REV | Revenue Code Type

RHC | Rural Health Clinic

RPPO | Regional Preferred Provider Organization

RX | Prescription | It's from the Latin word "Recipe" which was abbrieviated by a strike through the R

SAMHSA | Substance Abuse and Mental Health Services Administration

SMHP | State Medicaid Health Information Technology Plan

SNF | Skilled Nursing Facility | Generally long term care

SPD | Summary Plan Description

SSN | Social Security Number

TIN | Tax Identification Number | For an individual this is usually the SSN, for a provider its usually the EIN

TMR | Transmittal of Medical Records

TPA | Third Party Administrator

UB | Uniform Bill | Format used for institutions like hospitals

UC | Usual and Customary | The typical retail price without insurance

UCR | Usual and Customary Rates | The typical retail price without insurance

UMR | United Medical Resources | This is a TPA owned by UnitedHealthcare Group

VA | Veteran Affairs

VHA | Veteran Health Administration

WHO | World Health Organization