System of coding for integrative health care that consists of five-character alphabetic symbols with appended two-character practitioner modifiers that represent the practitioner type. These codes represent more than 4000 integrative health care products and services (Box A-2 ). ABC codes include the following specialty areas: acupuncturist, body work, chiropractic, conventional nursing, indigenous medicine, mental health care, minority health care, oriental medicine, physical medicine, spiritual and prayer-based healing, Ayurvedic medicine, botanical medicine, clinical nutrition, holistic dentists and physicians, homeopathy, massage therapy, midwifery, naturopathic medicine, osteopathic medicine, and somatic educational. ABCs were used to bill for these services as a pilot study maintained by Alternative Link, Inc. As of October 16, 2006, Alternative Link discontinued its pilot study. Covered entities under HIPAA may not use the codes in HIPAA transactions but may use the codes for non-HIPAA transactions. Also called advanced billing concept (ABC) codes. See also integrative health care and alternative medicine. Website: www.alternativelink.comBox A-2ABC CODE WITH MODIFIERThe following description illustrates the coding hierarchy of ABC code with modifier:CEBAM-1G High-risk pregnancy identification, Antepartum, Midwifery, Practice specialties
Insurance Encyclopedia
Alternative care
1. Nontraditional medical care given by providers such as acupuncturists. 2. Medical care received instead of inpatient hospitalization (e.g., outpatient surgery, home health care, skilled nursing facility care).
Alternative care facility (ACF)
Assisted living facility for elderly who do not need nursing care. ACFs have private and semiprivate rooms for residents and are usually near shopping and entertainment resources.
Alternative delivery system (ADS)
Phrase that indicates any other health care system other than the traditional fee-for-service or indemnity insurance.
Alternative dispute resolution (ADR)
Method or procedure used to settle insurance claims other than through a lawsuit. See also arbitration.
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UK: A generic term meaning all methods of dispute resolution other than the court. ADR embraces: arbitration, adjudication, conciliation, early neutral evaluation, expert determination, executive tribunal (or mini-trial) or mediation. ADR is actively encouraged as a part of the pre-action protocols in the Civil Procedure Rules.
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Methods other than lawsuits that are designed to resolve legal disputes. Examples are arbitration and mediation.
Alternative dispute resolution (Health Insurance)
Alternatives to the fee for service model, for example PPOs or HMOs. See entries PPO and HMO.
Alternative financing system (AFS)
Another system for financing medical services that is different from a fee-for-service method (e.g., capitation).
Alternative funding mechanism
Method designed to provide the account with a more favorable cash flow (e.g., self-funding and deferred premiums).
Alternative markets
Mechanisms used to fund self-insurance, including captives, which are insurers owned by one or more non-insurers to provide owners with coverage. Risk-retention groups, formed by members of similar professions or businesses to obtain liability insurance, are also a form of self-insurance.
Alternative medicine
Nontraditional medical care given by providers such as acupuncture, aroma therapy, chiropractic, diet, exercise, faith healing, homeopathy, Indian Ayurvedic medicine, massage, meditation, mind/body therapies, nutritional and herbal medicine, stress management, and therapeutic touch. A number of health insurance companies and managed care organizations have begun to provide insurance coverage for a few of these alternative therapies. Alternative billing codes (ABCs) are used to bill for these services. Also see integrative health care and alternative billing codes (ABCs). Website: www.alternativelink.com