1. Health care industry group that has a formal consultative role under the Health Insurance Portability and Accountability Act (HIPAA) legislation (also sponsors Strategic National Implementation Process [SNIP], a workgroup for electronic data interchange that improves health care through electronic commerce). 2. Policy advisory subgroup of the Accreditation Standards Committee X12 that has been involved in creating electronic data interchange standards for insurance billing transactions. Also see policy advisory group.

United Nations specialized agency for health that was established in April 1948. WHO’s objective, as set out in its Constitution, is the attainment by all peoples of the highest possible level of health. Health is defined in WHO’s Constitution as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. WHO is governed by 192 Member States through the World Health Assembly. The Health Assembly is composed of representatives from WHO’s member states. The main tasks of the World Health Assembly are to approve the WHO program and the budget for the following biennium and to decide major policy questions. WHO maintains the International Classification of Diseases (ICD) medical code set.

Supplemental health benefit plan that pays for medical costs such as copayments and deductibles not covered by a primary benefit plan such as Medicare or TRICARE. Also called Medigap (MG) policy, gap fill, Medifill , and Medicare supplement policy .

In the Medicaid program, medical services not usually covered by managed care plans but covered either by referral or direct access to fee-for-service providers.

Order issued in writing by a court of law (e.g., subpoena).

Legal order by a court compelling a regulatory officer (insurance commissioner) to perform a specific act.

1. Assets or debts that have been determined to be uncollectable and are therefore adjusted off the accounting books as a loss. This does not represent a discount. 2. Difference between the total fee the provider billed for a medical service and the insurance company’s allowed fee for the service.

Misrepresentation or to withhold crucial facts in an adoption case (e.g., withholding medical or mental health history about a child when the parents expect to have a healthy child).

Termination of a life caused by a wrongful act, neglect, or fault (liability situation).X