Organization that Health and Human Services (HHS) has designated for oversight of the business data content of one or more of the Health Insurance Portability and Accountability Act (HIPAA)-mandated transaction standards.

Under federal Stark II laws, there are 11 types of health care services that a physician is prohibited from referring if he or she has a financial relationship. These services include clinical laboratory, physical therapy (including speech-language pathology services), occupational therapy, radiology (including magnetic resonance imaging, computerized axial tomography scans, and ultrasound), radiation therapy services and supplies, durable medical equipment and supplies, parenteral and enteral nutrients, equipment and supplies, prosthetics, orthotics and prosthetic devices and supplies, home health services, outpatient prescription drugs, and inpatient and outpatient hospital services.

Facility under contract with a managed care plan to provide medical services to members of the plan. In an emergency situation, a member can save money by using a designated hospital instead of one that is not designated in the plan.

Facility or physician hired by a health plan to provide mental health and substance abuse services.

Individual or location authorized by a managed care plan to give mental health and substance abuse care to the plan’s members.

Under the Health Insurance Portability and Accountability Act (HIPAA), a group of records maintained by or for a covered entity that is (1) the medical records and billing records about individuals maintained by or for a covered health care provider; (2) the enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (3) used, in whole or in part, by or for the covered entity to make decisions about individuals.