...
For purposes of this part, the following definitions apply:
Code set
means any set of codes used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes. A code set includes the codes and the descriptors of the codes.
Code set maintaining organization
means an organization that creates and maintains the code sets adopted by the Secretary for use in the transactions for which standards are adopted in this part.
Covered health care provider means a health care provider that meets the definition at paragraph (3) of the definition of “covered entity” at §160.103.
Data condition
means the rule that describes the circumstances under which a covered entity must use a particular data element or segment.
Data content
means all the data elements and code sets inherent to a transaction, and not related to the format of the transaction. Data elements that are related to the format are not data content.
Data element
means the smallest named unit of information in a transaction.
Data set
means a semantically meaningful unit of information exchanged between two parties to a transaction.
Descriptor
means the text defining a code.
Designated standard maintenance organization (DSMO)
means an organization designated by the Secretary under §162.910(a).
Direct data entry
means the direct entry of data (for example, using dumb terminals or web browsers) that is immediately transmitted into a health plan's computer.
Format
refers to those data elements that provide or control the enveloping or hierarchical structure, or assist in identifying data content of, a transaction.
HCPCS
stands for the Health [Care Financing Administration] Common Procedure Coding System.
Maintain
or maintenance refers to activities necessary to support the use of a standard adopted by the Secretary, including technical corrections to an implementation specification, and enhancements or expansion of a code set. This term excludes the activities related to the adoption of a new standard or implementation specification, or modification to an adopted standard or implementation specification.
Maximum defined data
set means all of the required data elements for a particular standard based on a specific implementation specification.
Operating rules
means the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications as adopted for purposes of this part.
Segment
means a group of related data elements in a transaction.
Stage 1 payment initiation
means a health plan’s order, instruction or authorization to its financial institution to make a health care claims payment using an electronic funds transfer (EFT) through the ACH Network
Standard transaction
means a transaction that complies with an applicable standard adopted under this part.
[65 FR 50367, Aug. 17, 2000, as amended at 68 FR 8374, Feb. 20, 2003; 74 FR 3324, Jan. 16, 2009; 76 FR 40495, July 8, 2011; 77 FR 1589, Jan. 10, 2012; 77 FR 54719, Sept. 5, 2012; 84 FR 57629, Oct. 28, 2019]