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HIPAA Glossary of Terms



Business Associate (BA)
A person or organization that performs a function or activity on behalf of a covered entity, but is not part of the covered entity's workforce. A business associate can also be a covered entity in its own right

Code Set
Any set of codes used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes. This includes both the codes and their descriptions.

Covered Entity (CE)
Any business entity that must comply with HIPAA regulations, which includes health-care providers, health plans and health-care clearinghouses. For purposes of HIPAA, health-care providers include hospitals, physicians and other caregivers.

CPT - Current Procedural Terminology
A 5-digit code used in medical billing and records systems that defines the medical procedures and medical services provided.



Electronic Data Interchange (EDI)
X12 and similar formats for the electronic exchange of structured data. It is sometimes used more broadly to mean any electronic exchange of formatted data.

Electronic Health Record (EHR)
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

Electronic Medical Record (EMR)
An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health-care organization.

HCFA Common Procedural Coding System (HCPCS)
A medical coding system used to describe what treatment or services were provided by a physician. The HCPCS Level II Coding books contain codes and descriptions for durable medical goods, injections, supplies and services not listed by CPT Coding books.

Health Level Seven (HL7)
A data exchange protocol and interface for medical records and billing software that allows different systems to interoperate.

ICD-9 (International Classification of Diseases)
The 9th edition numerical code set used in medical billing describing a diagnosis or medical procedure to treat a disease, syndrome or disorder.

ICD-10 (International Classification of Diseases)
The 10th edition numerical code set that is the successor to ICD-9.

National Drug Code (NDC)
A medical code set that identifies prescription drugs and some over the counter products, and that has been selected for use in the HIPAA transactions

Personal Health Record (PHR)
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

Trading Partner Agreement (TPA)
An agreement related to the exchange of information in electronic transaction between each party to the agreement.

X12
ANSI-accredited group that defines EDI standards for many American industries, including health care insurance. Most of the electronic transaction standards mandated or proposed under HIPAA are X12 standards.