Terms, Acronyms, and Abbreviations

Term, Acronym, or Abbreviations

Definition

A

ACL

Adjudicated Claim Line

ACN

Attachment Control Number. A number assigned by the PROMISe™/LIHEAP Vendor Internet that connects attachments, such as trip tickets or shut-off notices, to the electronic claim.

Adjudicate

To determine whether a claim is to be paid or denied.

Adjudicated Claim

A claim that has reached final disposition such that it is either to be paid or denied.

AIN

Attachment Image Number. The number assigned to attachments once scanned.

Allowed Amount

The maximum amount LIHEAP will pay for a service as billed.

API

Application program interface

Audit

System logic used to enforce policy, claims processing, and pricing by comparing a new-day claim to claims in history.

Authorization Number

The number assigned by OIM that authorizes a vendor to deliver a service or product and bill for that service or product. Also known as a Crisis Authorization Number.

B

Billed Amount

The amount billed to LIHEAP for a rendered service.

Browser

Software for a PC workstation that allows the user to access information via the Internet or an internal Intranet.

C

CAO

County Assistance Office – these offices administer all DHS benefit programs at the local level.

Case Management

A health care method in which medical, social, and other services for a recipient are coordinated by one (1) entity.

Case Manager

An individual who coordinates, monitors, and ensures that appropriate and timely care is provided to the recipient.

Claim

A request for payment for services rendered.

Crisis Authorization Number

The number assigned by OIM that authorizes a vendor to deliver a service or product and bill for that service or product.

Criteria

Standard rules for a recipient to become LIHEAP eligible.

D

Date of Service 

Date or dates on which a recipient receives a covered service.  Documentation of services and units received must be in the recipient’s record for each date of service.

Delivery Date

The date that the services were rendered or the items were delivered.

Demographic

Data used to identify eligibility standards.

Denial

A claim for which payment is disallowed.

Deny

A disposition that denies a claim line or entire claim.

Detail

The detail area of a claim includes line item information such as the service code, units billed, and billed amount for each service code.

Disposition

An action or result that will occur if an error status code (ESC) sets. There are three disposition classifications: pay, deny, and suspend.

DOB

Date of Birth

DOD

Date of Death

DOS

Date of Service

DHS

Department of Human Services

Duplicate Claim  

A claim which has been submitted or paid previously or a claim which is identical to a claim in process.

E

eCIS

Electronic Client Information System – the DHS system that maintains demographic and eligibility information for all LIHEAP recipients.

Edit

System logic used to enforce policy, claims processing, and pricing for new-day claims.

EFT

Electronic Funds Transfer

EIN

Employer Identification Number

Eligible

(1) To be qualified for LIHEAP benefits.  (2) One who is qualified for benefits.

Error Code

A numeric code indicating the type of error found in processing a claim.

ESC

Error Status Code. A numeric code used to identify an edit or audit.

F

FEIN

Federal Employer Identification Number

Field Audit

An activity performed whereby a vendor’s facilities, procedures, records and books are audited for conformance to LIHEAP standards.  A field audit may be conducted on a routine basis, or on a special basis.

Fiscal Year (FY)

The twelve-month period between settlements of financial accounts.

Forced Deny

Resolves a suspended ESC by manually changing ESC disposition from suspend to deny.

Forced Error

Resolves a suspended ESC by manually changing disposition from suspend to pay (claim may deny on other ESCs).

G

H

Header

The header area of a claim includes information such as the Vendor/Provider ID, Recipient ID, Crisis Authorization Number, and net billed amount.

HP

Hewlett-Packard

HP Enterprise Services

A subsidiary of Hewlett-Packard.

I

ICN

Internal Control Number; the number assigned to an invoice in PROMISe.

In-Process Claim (Pending Claim)

A claim, which suspends during system processing for suspected error conditions because all processing requirements are not met.  These conditions must be reviewed by HP or DHS and resolved before processing of the claim can be completed.  (See suspended claim)

Inquiry

A request for information.

Internal Control Number ICN)

The unique 13-digit claim number that appears on a Remittance Advice.

Internet

A worldwide system of computer networks - a network of networks in which users at any one computer can, if they have permission, get information from any other computer (and sometimes talk directly to users at other computers). It was conceived by the Advanced Research Projects Agency (ARPA) of the U.S. government in 1969 and was first known as the ARPANET.

Intranet

A privately maintained computer network that can be accessed only by authorized persons, especially members or employees of the organization that owns it.

J

Julian Date

Chronological date of the year, 001 through 365 or 366, preceded by a two (2)-digit year designation.  Claim number example:  09231. 

K

L

LCRIS

A service program “LIHEAP Crisis.”

LIHEAP

Low Income Home Energy Assistance Program

Line Item

A service provided to a recipient.  A claim may be made up of one or more line items for the same recipient.  Also called a claim detail.

LOK

A special indicator; stands for “LIHEAP Oil – Kerosene Discount Program.”

LRP

A special indicator; stands for “LIHEAP-Regulated Provider.”

M

MPI

Master Provider Index

N

O

OIG

Office of the Inspector General (Pennsylvania Department of Human Services)

OIM

Office of Income Maintenance (Pennsylvania Department of Human Services)

OIS

Office of Information Services (Pennsylvania Department of Human Services)

OIT

Office of Information Technologies (Pennsylvania Department of Human Services)

OLA

Office of Legislative Affairs  (Pennsylvania Department of Human Services)

OLRD

Office of Licensing and Regulatory Development  (Pennsylvania Department of Human Services)

OPD

Office of Policy Development  (Pennsylvania Department of Human Services)

On-Line

Use of a computer workstation with visual display to immediately access computer files.

P

PA PROMISe™

Pennsylvania Provider Reimbursement and Operations Management Information System in electronic format.

Pay and List

A disposition that posts a given ESC and sets the status to “pay.”

PEP

Provider Eligibility Program. Identifies the type or group of service the vendor is eligible to perform (i.e., LIHEAP).

Place of Service (POS)

An alpha or numeric code denoting the actual place services are provided.

Procedure Code

A five-character code for the service or type of heating delivery (e.g. Y9000 = LIHEAP – Electric). This is also known as a Service Code.

Program Code

A series of codes reflecting the various programs in which the recipient is active for the particular eligibility period; the client may be assigned more than one program code at a time.

Provider/Vendor

An entity enrolled in the LIHEAP Program that provides services or supplies to recipients. Also known as a vendor.

Provider/Vendor Specialty

Defines a provider or vendor more specifically than a provider type.

Provider/Vendor Type

Defines a provider or vendor in terms of the type of service provided.

Q

Quality Assurance

Determination of quality and appropriateness of services rendered.

R

Recipient

Person who eligible to receive services under LIHEAP. Also known as a client or consumer.

Reimbursement

The amount of money remitted to a provider or vendor.

Rejected Claim

A claim for which payment is refused.

Remittance Advice (RA)

A notice sent to vendors advising the status of claims received, including paid, denied, in-process and adjusted claims.  It includes year-to-date payment summaries and other financial information.

RID

Recipient Identification Number; also known as a Recipient ID. This is the number assigned by PROMISe to a client or consumer.

S

Sanction

Any corrective action taken against a vendor.

Service Code

A five-character code for the service or type of heating delivery (e.g. Y9000 = LIHEAP – Electric). This is also known as a Procedure Code.

Service Location

A logical grouping of information about a vendor that differentiates information within a Legal Entity (e.g. type and physical address). A vendor may have one or many service locations.

Service Program

Defines a recipient benefit program (e.g. LCRIS = LIHEAP Crisis).

Shut-off Notice

A notice announcing the disconnection of a utility service.

Specialty

The specialized area of practice of a vendor.

SSN

Social Security Number

State Plan (LIHEAP)

A comprehensive written commitment by the Department of Human Services to help low-income households in the Commonwealth meet their home-heating needs.

Suspend

A disposition that suspends or holds a claim for manual review and resolution.

Suspended Claim

An “In-Process Claim” which must be reviewed and resolved.

Suspension of Payments

The withholding of all payments due to a vendor until the resolution of a matter in dispute between the vendor and the state agency.

T

Trip Ticket

A record detailing the specifics of a LIHEAP delivery that will accompany that delivery.

Turnover

Refers to the period of time for the transition from the current vendor to a replacement vendor either at the fulfillment of the contract or in the event of contract termination during the term of the contract.

U

USPS

United State Post Office

Utility Vendor

An offeror of heating goods and services.

V

VT

Voucher Transmittal

W

WAN

Wide Area Network

Withholding of Payments

A reduction or adjustment of the amounts paid to a vendor on pending and subsequently due payments.

WYSIWYG

What you see is what you get. This term refers to the expected appearance or display of data in a graphical user interface (GUI) or desktop window.

X

XML

Extensible Markup Language

Y

YTD

Year to Date