LICENSES AND NOTICES

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


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EDI Glossary

A

American National Standards Institute (ANSI) Format:

Stream file format that uses transactions, segments, elements, identifiers, and delimiters. All data lengths are variable in this format. Specifications for the HIPAA-compliant ANSI X12N version 4010A1 implementation guides are available on the Washington Publishing Company Website. Per HIPAA implementation, this format is mandatory of the healthcare community.

Asynchronous Transmission:

In modem communication, a form of transmission in which data is sent intermittently, one character at a time, rather than a steady stream with characters separated by fixed time intervals.

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B

Beneficiary Eligibility:

A feature that enables providers to electronically access information regarding the eligibility data of beneficiaries.

Billing Service:

An entity that provides claims services to providers. It compiles medical information to build and transmit claims. They will collect claim information from a provider electronically or on paper and will bill the appropriate insurance payer. Note: You are responsible for verifying that claims are being transmitted electronically, and for the accuracy of claims that a billing service sends to CGS on your behalf.

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C

CGS Free Billing Software:

As a service to our providers, CGS offers a software package which allows billers to create an electronic claim file. For information, refer to the PC-ACE Pro32 Software Web page.

Claim Status Inquiry (CSI):

A feature that allows suppliers and providers to electronically check the status of claims. Find out if your claims have been paid, denied, or are still pending. EDI accepts the current ANSI X12 276/277 Claims Status Inquiry/Claims Status Response paired transaction sets.

Claim File:

Once claim data is entered into your Medicare billing software, the billing software then compiles the data and develops an electronic file in the National Standard or ANSI X12 format. This file is then transmitted electronically to CGS.

Clean Claim:

A claim that does not require investigation or development outside the Medicare operation on a prepayment basis.

Clearinghouse:

An entity that transfers or moves EDI transactions for a provider. A clearinghouse accepts multiple types of claims and sends them to various payers, including Medicare. Note: You are responsible for verifying that claims are being transmitted electronically, and for the accuracy of claims that a billing service or clearinghouse sends to CGS on your behalf.

Communications Software:

The software that enables one to send or receive information from one computer to another.

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E

277CA Claims Acknowledgement:

A report that lists the number of claims received and accepted/rejected by CGS. This report will also show any errors that occurred which caused claims to reject and not get into the system.

EDI Application:

This form is used to provide CGS with your provider and vendor information as well as the type of request you are submitting. It is to be completed and submitted for all request for electronic transactions. This form is also used to communicate configuration changes. These changes range from contact name, address change, software vendor/billing service/clearinghouse change, data request changes or ceasing electronic billing.

Electronic Data Interchange (EDI):

The computer-to-computer electronic exchange of business documents using standard formats.

EDI Enrollment Form:

A CMS agreement stating that the provider is responsible for the Medicare claims sent by itself, its employees, or its agents. Each provider of health care services, physician, or supplier that intends to submit electronic media claims (EMC) must execute the agreement. The CMS EDI Enrollment Form must be completed prior to submitting EMC to Medicare. The signed form must be on file for each Medicare carrier that processes your claims before production claims may be transmitted.

Electronic Funds Transfer (EFT):

Automatically transferring payment to a provider's bank account.

Electronic Media Claims (EMC):

Transmitting claims by computer rather than submitting them on paper.

 
 
Electronic Remittance Notice (ERN):

An electronic payment report, which lists claims that have been paid and/or denied. The ERN process may permit the provider to utilize automatic posting capability if they use a practice management system.

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F

Functional Acknowledgment Reports:

A report generated in the ANSI format to recognize received ANSI X12N files. This report is generated for each transaction received by CGS that contains enough data in a valid format to identify the user.

I

Internal Control Number (ICN):

A tracking number assigned by CGS to claims that were accepted into its claims processing system.

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M

Medicare Remit Easy Print (MREP):

Free software offered to providers. This software is used for viewing and printing theANSI ASC X12 835 HIPAA compliant Electronic Remittance Advice (ERA) and is available for installation via the Centers for Medicare and Medicaid Services (CMS) websiteExternal Website.

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P

Payment Floor:

The minimum amount of time a claim must be held before payment can be released. EMC claims must remain on the payment floor 13 days before payment is released. Paper claims must remain on the payment floor for 28 days before payment is released.

Proprietary Software:

This software is written or developed in-house for a company, and tailored to the specific needs of that company. Specifications for the HIPAA compliant ANSI X12N implementation guides are available on the Washington Publishing Company websiteExternal Website.

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R

Reader (Program):

A software program which is designed for the purpose of converting raw data to a recognizable format for interpretation.

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S

 
 
Submitter ID:

An identification number assigned by the Part B Electronic Data Interchange department to identify electronic billers. Part B billers will be issued a separate Submitter ID by each Part B carrier to whom they transmit claims electronically.

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V

Vendor:

An entity that provides hardware, software, and/or ongoing technical support for providers.

Vendor Software:

Software written or developed by a third party entity (vendor) so that providers might submit claims to CGS. If you already use vendor software to manage your practice, contact the vendor to see if they offer a feature for submitting claims to Medicare.

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