- 5010 – latest version of HIPAA's transaction standards
- AAC – Actual Acquisition Cost; the net cost of a drug paid by a pharmacy
- AAPC – Adjusted Average Per Capita Cost; the amount of funding a Medicare managed care plan receives from CMS to cover its costs.
- ACO – Accountable Care Organization
- ADA – 1. American Dental Association 2. Americans with Disabilities Act
- ADAP – Aids Drug Assistance Program
- ADL – Activities of Daily Living; activities performed by individuals without assistance
- AFDC/TANF – Aid to Families w/ Dependent Children; Temporary Assistance for Need Families
- AHLAT – Armed Forces Health Longitudinal Technology Application; DoD's electronic health record system
- AHRQ – Agency for Healthcare Research and Quality
- ANSI – American National Standards Institute
- APA – Advanced Planning Document
- APC – Ambulatory Payment Classification
- APD – Advance Planning Document
- APG – Ambulatory Patient Groups
- APHSA – American Public Human Services Association
- ARRA – American Recovery & Reinvestment Act of 2009
- ASC X 12 – Official Designation of the US National Standards Body for the Development and Maintenance of electronic data
- ASCII - American Standard Code for Information Interchange
- BAA – Business Associate Agreement
- BENDEX – Beneficiary and Earnings Data Exchange
- BI – Business Intelligence
- BPM – Business Process Model
- CAP – Cost Allocation Plan
- CAQH – The Council for Affordable Quality Healthcare
- CBA – Cost Benefit Analysis
- CCF – Computer Based Training
- CCHIT – Certification Commission for Healthcare Information Technology
- CCI – Correct Coding Initiative; a large set of Procedure Code edits adopted by Medicaid
- CDC – Centers for Disease Control
- CDCP – Center for Disease Control and Prevention
- CDM – Conceptual Data Model
- CESA – Cooperative Education Service Agency
- CFR – Code of Federal Regulations
- CHIP – Children's Health Insurance Program
- CHIPRA – Children's Health Insurance Program Reauthorization Act of 2009
- CLIA – Clinical Laboratory Improvement Act of 1988
- CM - Clinical Management
- CMCS - Center for Medicaid, CHIP, and Survey and Certification
- CMHC – Community Mental Health Centers
- CMI – Case Mix Indicator
- CMMI – Capability Maturity Model Integration
- CMS – Centers for Medicare and Medicaid Services
- COB – Coordination of Benefits
- COB – Coordination of Benefits
- COBA – Coordination of Benefits Agreement
- COLA – Cost of Living Adjustment
- COS – Category of Service
- COTS – Commercial off-the-shelf software
- CPAS – Claims Processing Assessment System
- CPHA – Community of Professional and Hospital Activities
- CPT – Current Procedural Terminology
- CRF – Community Resident Facility
- CRN – Claim reference number
- CRNP – Certified Registered Nurse Practitioner
- CSR – Customer Service Representative
- DAW – Dispense as written by a physician
- DBMS – An integrated comprehensive database management system
- DCN – Document Control Number
- DDI – Design, Development, and Implementation
- DEA – Drug Enforcement Agency
- DEERS – Defense Eligibility and Enrollment Reporting System
- DESI – Drug Efficacy Study Implementation
- DGB – Data Governance Board
- DHS – 1. Department of Human Services; 2. US Department of Homeland Security
- DHHS – US Department of Health and Human Services
- DME – Durable Medical Equipment
- DRG – Diagnosis Related Group
- DSD – Detailed System Design
- DSH – Disproportionate Share Hospital
- DSMO – Designated Standards Maintenance Organization
- DSS – Decision Support System
- DUR – Drug Utilization Review
- DW – Data warehouse
- EA – Enterprise Architecture
- EAC – Estimated Acquisition Cost for Drugs
- ECM – Enterprise Content Management
- EDH Interchange – Economic and Human Development
- EDI – Electronic Data Interchange
- EFT – Electronic Fund Transfer
- EHR – Electronic Health Record
- EMC – Electronic Media Claims, same as ECS
- EMR – Electronic Medical Record
- EOMB – Explanation Of Medical Benefits; Explanation of Medicare Benefits
- EOP – Explanation of Payments
- ePHI – Electronic Protected Health Information
- EPSDT – Early and Periodic Screening Diagnosis and Treatment
- EQRO – External Quality Review Organization, same as PRO
- ERP – Estate Recovery Program. Medicaid is able to collect against the estate of deceased recipients 55 or older when assistance was issued.
- ESB – Enterprise Service Bus
- ETL – Extract, Transform, and Load
- EVS – Eligibility Verification System
- FA – Fiscal Agent
- FFP – Federal Financial Participation
- FHA – Federal Health Architecture
- FMAC – Federal Maximum Allowable Cost
- FMAP – Federal Medical Assistance Percentage
- FPL – Federal Poverty Level
- FPW – Family Planning Waiver
- FQHC – Federally Qualified Health Center
- GAMC – General Assistance Medical Care
- GPRA – Government Performance Results Act
- HCBS – Home and Community Based Service
- HCBW – Home and Community Based Waiver
- HCPCS – Healthcare Common Procedure Coding System
- HDX – Healthcare Data Exchange
- HEDIS – Health Information Employer Data and Information Set
- HHS – Department of Health and Human Services
- HIE – Health Information Exchange
- HIMSS – Health Information and Management Systems Society
- HIPP – Health Insurance Premium Payment
- HIPAA -The Health Insurance Portability and Accountability Act of 1996
- HISPC – Health Information Security and Privacy Collaboration
- HIT – Health Information Technology
- HITECH – Healthcare Information Technology for Economic & Clinical Health Act
- HITSP – Healthcare Information Technology Standards Panel
- HIX – Health Insurance Exchange
- HL7 – Health Level 7 – Global authority in standards for interoperability of HIT
- HMO - Health Maintenance Organization
- IAPD – Implementation Advance Planning Document
- IBP – Industry Best Practices
- ICD-10 – Intl. Statistical Classification of Disease and Related Health Problems 10th Rev.
- IC-MR – Intermediate Care Facility for the Mentally Retarded
- ICN – Internal Control Number; used to uniquely qualify MMIS health care claims
- IDIQ – Indefinite Delivery/Indefinite Quantity
- IEE - Integrated Eligibility and Enrollment (a mandate of PPACA law of 2009)
- IEEE – Industrial Electrical and Electronic Engineers
- IEP – Individual Education Plan
- IHE – Integrating the Healthcare Enterprise
- IHS – Indian Health Service
- IMD – Institute for Mental Disease
- ISO – International Organization for Standardization
- ISP – Individual Service Plan
- ITB – Intent to Bid
- ITIL – Information Technology Infrastructure Library
- IV&V - Independent Verification and Validation
- JAD – Joint Application Design
- JAR – Joint Application Requirements
- LDM – Logical Data Model
- LTC – Long Term Care
- MARS – Management and Administrative Reporting Subsystem
- MBES – Medicaid Budget and Expenditure System
- MCH – Maternal and Child Health
- MCO – Managed Care Organization
- MECT – Medicaid Enterprise Certification Toolkit
- MEQC – Medicaid Eligibility Quality Control
- MFCU – Medicaid Fraud Control Unit
- MITA – Medicaid Information Technology Architecture
- MMA – Medicare Modernization Act
- MMIS – Medicaid Management Information System
- MOTS – Modified Off-the-Shelf
- MSIS – Medicaid Statistical Information System, formerly MEDSTAT
- NAMPI - National Association for Medicaid Program Integrity (replaces NASO, National Association of SURS Officials)
- NASCIO – National Association of State Chief Information Officers
- NCPCP – National Council for Prescription Drug Programs
- NDC – National Drug Code
- NHIS – National Health Information Systems
- NIST – National Institute of Standards and Technology
- NMEH – National Medicaid EDI HIPAA Workgroup
- NPDP – National Practitioner Data Bank
- NPI – National Provider Identifier
- NPI Enumerator – The CMS contractor responsible for assisting health care providers in applying for their NPIs and updating their information in NPPES
- NPP – Notices of Privacy Practices
- NPPES – National Provider and Plan Enumeration System
- NwHIN – Nationwide Health Information Network
- OASIS – Outcome and Assessment Information Set
- OBRA – Omnibus Budget Reconciliation Act
- OLAP – On-line Analytical Processing
- ONC – Office of the National Coordinator for Health Information Technology
- OPPPS – Outpatient Prospective Payment System
- OSCAR – Online Survey Certification and Reporting
- P4P – Pay for Performance
- PA – Prior Authorization
- PACE – Pharmaceutical Assistance Contract for the Elderly
- PAM – Payment Accuracy Measurement
- PAPD – Planning Advance Planning Document
- PARIS – Public Assistance Reporting Information System
- PASARR – Pre-Admission Screening and Resident Review
- PBM – Pharmacy Benefit Management/Manager
- PCCM – Primary Care Case Manager
- PCP – Primary Care Physician/Provider
- PCPCM – Primary Care Physician Case Manager.
- PCS – Procedure Coding System
- PDA – Personal Digital Assistant
- PE – Presumptive Eligibility
- PECOS – Provider Enrollment Chain and Ownership System
- PERM – Payment Error Reduction and Measurement
- PHDSC – Public Health Data Standards Consortium
- PHI – Protected Health Information
- PHIN – Public Health Information Network of the Centers for Disease Control and Prevention (CDC)
- PHP – Prepaid Health Plan
- PHR – Personal Health Record
- PIP – Periodic Interim Payment
- PKI – Public Key Infrastructure
- PMBOK – Project Management Body of Knowledge
- PMI – Project Management Institute
- PMO – Project Management Office
- PMP – Project Management Professional
- PPACA – Patient Protection and Affordable Care Act, 2009
- PPO – Preferred Provider Organization
- PSTG – Private Sector Technology Group
- QA – Quality Assurance
- QC – Quality Control
- QDWIs – Qualified Disabled and Working Individuals
- QM – Quality Management
- QMB – Qualified Medicare Beneficiary
- RAC – Recovery Audit Contractor
- RAMS – Requirements Analysis Management System
- REC – Regional Extension Center
- RHIO – Regional Health Information Organization
- REOMB – Recipient Explanation of Medical Benefits
- ROSI – Reconciliation of State Invoice
- RUG – Resource Utilization Group
- SACWIS – Statewide Automated Child Welfare Information System
- SAMHSA – Substance Abuse and Mental Health Services Administration
- SCHIP – State Children's Health Insurance Program, currently named CHIP
- SDLC – Software Development Life Cycle
- SEI – Software Engineering Institute
- SDO – Standards Development Organization
- SDW – Shared Data Warehouse
- SDX – State Data Exchange
- SLA – Service Level Agreement
- SMHP – State Medicaid Health Information Technology (HIT) Plan
- SME – Subject Matter Expert
- SMM – State Medicaid Manual
- SNF – Skilled Nursing Facility
- SNIP – Strategic National Implementation Process
- SOA – Service Oriented Architecture
- SOBRA – Sixth Omnibus Budget Reconciliation Act
- SOLQ – State Online Query to Social Security Administration
- SOW – Scope of Work
- SQL – Structured Query Language
- SS-A – State Self Assessment (a component of MITA)
- SSA – Social Security Administration
- SSOP – Second Surgical Opinion Program
- S-TAG – State Systems Technical Advisory Group
- SURS – Surveillance Utilization Review subsystem
- TANF – Temporary Assistance for Needy Families
- TPA – Trading Partner Agreement – an agreement between HIPAA trading partners
- TPL – Third-Party Liability
- VA – US Department of Veteran Affairs
- WEDI – Workgroup for Electronic Data Interchange
- WIC – Women, Infants, and Children – Federal program to ensure proper nutrition
- X12 – The ANSI Committee responsible for Electronic Data Interchange standards