45 CFR 162.103 - Definitions.
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.
Controlling health plan (CHP) means a health plan that -
(1) Controls its own business activities, actions, or policies; or
(i) Is controlled by an entity that is not a health plan; and
(ii) If it has a subhealth plan(s) (as defined in this section), exercises sufficient control over the subhealth plan(s) to direct its/their business activities, actions, or policies.
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 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.
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.
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.