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GLOSSARY OF TERMS

 

AWP

Bene

CFR

CMS

DAW

DEA

DESI

DOJ

DOS

DP

DUR

EDI

EPHI

ERISA

FBI

FDA

FDB

FUL

FWA

GCN

GNI

GPI

HIPPA

IT

MAC

MEDIC

MMA

MHA

NDC

NPI

OAG

PBM

PHI

PBM

 

RB

Qty

Retrospective Audit

ROI

Sox

TPA

U&C

WAC

 

Average Wholesale Price

Beneficiaries

Code of Federal Regulations

Center for Medicare and Medicaid Services

Dispense as Written

Drug Enforcement Agency

Drug Product Efficacy Study and Implementation

Department of Justice

Date of Service

Direct Price

Drug Utilization Review

Electronic Data Interchange

Electronic Protected Health Information

Employee Retirement Income Security Act

Federal Bureau of Investigation

Food & Drug Administration

First DataBank

Full Upper Limit (formerly HCFA MAC)

Fraud, Waste & Abuse

Generic Code Number

Generic Named Drug Indicator

Generic Price Indicator

Health Insurance Portability & Accountability Act

Information Technology

Maximum Allowable Cost

Medicare Drug Integrity Contractor

Medicare & Medicaid

Morgan Healthcare Audits, LLC

National Drug Code

National Prescriber Identifier

Office of Attorney General

Pharmacy Benefit Manager

Protected Health Information

Prospective Audit Review of current claims prior to payment to PBM

RB Redbook

Quantity

Review of claims for a past period after payment has been made to PBM

Return on Investment

Sarbanes Oxley

Third Party Administrator

Usual and Customary

Wholesale Acquisition Cost

 

 

 

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