Tenn. Comp. R. & Regs. 0780-01-73-.03

Current through June 26, 2024

Section 0780-01-73-.03 - DEFINITIONS

As used in these rules, unless the context requires otherwise:

(1) Uniform Claim Forms

(a) "UB-92, HCFA-1450 or CMS-1450" means the health insurance claim form maintained by HCFA/CMS for use by institutional care providers. Currently this form is known as the UB-92.

(b) "HCFA-1500 or CMS-1500 (12-90)" means the health insurance claim form maintained by HCFA/CMS for use by health care providers.

(c) "American Dental Association, 1999 Version 2000" means the uniform dental claim form approved by the American Dental Association (ADA) for use by dentists, as amended or updated by the American Dental Association.

(d) "NCPDP" means the National Council for Prescription Drug Program's claim form or its electronic counterpart.

(2) Uniform Claim Codes

(a) "ASA Codes" means the codes contained in the ASA Relative Value Guide developed and maintained by the American Society of Anesthesiologists to describe anesthesia services and related modifiers.

(b) "CDT-3 Codes" means the current dental terminology prescribed by the American Dental Association, including the terminology updates and revision issued in the future by the American Dental Association.

(c) "CPT-4 Codes" ("Level I Codes") means the Physicians' Current Procedural Terminology, Fourth Edition, published by the American Medical Association.

(d) "ICD-9-CM Codes" means the diagnosis and procedure codes in the International Classification of Diseases, Ninth Revision, clinical modifications published by the U.S. Department of Health and Human Services.

(e) "NDC" means the National Drug Codes of the Food and Drug Administration.

(f) "UB-92 Codes" means the code structure and instructions established for use by the National Uniform Billing Committee.

(g) "HCPCS Codes" ("Level II Codes") means the Health Care Financing Administration's Common Procedure Coding System. This means national codes developed by HCFA/CMS to supplement CPT codes. They include physical services not included in CPT as well as non-physician services such as ambulance, physical therapy and durable medical equipment. The acronym "HCPCS" stands for the HCFA/CMS Common Procedure Coding System.

(3) "Managed Care Organization" means TennCare program HMO or TennCare Partners program BHO that pays for, or reimburses for, the costs of health care expenses.

(4) "Provider" means any person, partnership, association, corporation or other facility or institution that renders or causes to be rendered health care or professional services to TennCare program enrollees or TennCare Partners program enrollees, and officers, employees or agents of any of the above acting in the course and scope of their employment.

(5) "HCFA or CMS" means the Centers for Medicare & Medicaid Services, formerly known as the Health Care Financing Administration of the U.S. Department of Health and Human Services.

Tenn. Comp. R. & Regs. 0780-01-73-.03

Original rule filed April 4, 2002; effective June 18, 2002. Amendment filed October 24, 2002; effective January 7, 2003.

Authority: T.C.A. §§ 56-32-218(a), 71-5-191, and Public Acts of2001, Chapter 209, § 1.