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.

Standard that Health and Human Services (HHS) has designated for use under the authority provided by the Health Insurance Portability and Accountability Act (HIPAA).

Association chosen by the Secretary of the United States Department of Health and Human Services to maintain standards adopted under Subpart 1 of 45 Code of Federal Regulations Part 162. A DSMO may receive and process requests for adopting a new standard or modifying an adopted standard.

A term used to describe a level of history and/or physical examination.

Extended examination of the affected body areas or other symptomatic or related organ systems.

Documentation must include the chief complaint, an extended history of presenting illness (HPI), an extended review of systems (ROS), and a pertinent past, family, and/or social history (PFSH).

Decision made to either pay in full, pay in part, or deny a claim.

Communication from the Internal Revenue Service (IRS) stating whether the design of the pension plan meets the criteria to be a qualified plan.