044-51 Wyo. Code R. § 51-2

Current through April 27, 2019

Section 51-2 - Definitions

As used in this regulation:

(a) "ASC X12N" and any future iterations, standard format means the standards for electronic data interchange within the health care industry developed by the Accredited Standards Committee X12N Insurance Subcommittee of the American National Standards Institute.

(b) "CDT Procedure Codes" means the current dental terminology prescribed by the American Dental Association.

(c) "CPT Codes" means the physicians' current procedural terminology published by the American Medical Association.

(d) "HCFA" means the Health Care Financing Administration of the U.S. Department of Health and Human Services.

(e) "HCFA Form 1450" means the health insurance claim form maintained by HCFA for use by institutional care practitioners.

(f) "HCFA Form 1500" means the health insurance claim form maintained by HCFA for use by health care practitioners.

(g) "HCPCS" means HCFA's Common Procedure Coding System, a coding system which describes products, supplies, procedures and health professional services and includes, the American Medical Associations (AMA's) Physician Current Procedural Terminology codes, alphanumeric codes, and related modifiers. This includes:

(i) "HCPCS Level 1 Codes" which are the AMA's CPT codes and modifiers for professional services and procedures.

(ii) "HCPCS Level 2 Codes" which are national alpha-numeric codes and modifiers for health care products and supplies, as well as some codes for professional services not included in the AMA's CPT.

(iii) "HCPCS Level 3 Codes" which are local alpha-numeric codes and modifiers for items and services not included in HCPCS Level 1 or HCPCS Level 2.

(h) "Health Care Practitioner" means:

(i) A chiropractor licensed under W.S. § 33-10-101 et seq.

(ii) A corporation or partnership of health care practitioners defined in this section.

(iii) A dentist licensed under W.S. § 33-15-101 et seq.

(iv) A nurse licensed under W.S. § 33-21-119 et seq.

(v) An optometrist licensed under W.S. § 33-23-101 et seq.

(vi) A physician licensed under W.S. § 33-26-101 et seq.

(vii) A podiatrist licensed under W.S. § 33-9-101 et seq.

(viii) A psychologist licensed under W.S. § 33-27-113 et seq.

(ix) A physical, speech and audiology, occupational, or respiratory therapist licensed under W.S. §§ 33-25-101 et seq.; 33-33-101 et seq.; 33-40-101 et seq.; or 33-43-101 et seq.

(x) A home health agency licensed under W.S. § 35-2-901(a).

(i) "ICD-CM Codes" means the diagnosis and procedure codes in the International Classification of Diseases, clinical modifications published by the U.S. Department of Health and Human Services.

(j) "Institutional Care Practitioner" means:

(i) A hospice;

(ii) A hospital;

(iii) A skilled nursing facility, extended care facility, intermediate care facility, convalescent nursing home, or personal care facility; and

(iv) A home health agency.

(k) "Issuer" means an insurance company, fraternal benefit society, health care service plan, health maintenance organization, and third party administrator, and any other public and or private entity reimbursing the costs of health care expenses.

(l) "J5xx Form" means the uniform dental claim form approved by the American Dental Association for use by dentists.

(m) "NDC," National Drug Code, means the identifying drug number maintained by the Food and Drug Administration (FDA).

(n) "NSF," National Standard Format, means a flat file format standard for submission of health care claims electronically.

(o) "Revenue Codes" means the codes established for use by institutional care practitioners by the National Uniform Billing Committee.

044-51 Wyo. Code R. § 51-2

Amended, Eff. 7/13/2017.