VFMP Acronyms and Abbreviations

Governments are confusing — here's some help

834 Form Electronic Eligibility File (X12 Format)

835 form Electronic transaction that provides claim payment information and documents the EFT (electronic funds transfer). An 835 is sent from insurers to the healthcare provider.

837 form HIPPA form utilized by healthcare organizations to communicate claims

8PDL 8-point Denial Letter

AES All employee survey

AO Administrative Officer

ARS Attachment Retrieval System

ATO Authority to Operate

AUSH Assistant Undersectary of Health

B1 Pharmacy Claims File (NCPDP Format)

B2 Pharmacy Reversal File (NCPDP Format)

BCPU Bene Claims Processing Unit

Bene Calc Short name for the Benefit Calculation process

BLUF Bottom Line Up Front

BOC Bill of Collection

BVA Board of Veterans Appeals

CAMO Claims Appeals Management Office

CARC/RARC Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC)

CAT CAP Catestrophic Cap – Out of pocket maximum

CCN Community Care Network

CCRS Community Care Reimbursement System

CDR Consolodated Data Repository

CE Claims Examiner

CHAMPVA Civilian Health and Medical Program of the Department of Veterans Affairs

CIPM Consolodated Intake & Processing for Mail

CITI CHAMPVA In-House Treatment Initiative

CLFMP Camp Lejeune Family Member Program

CMO Chief Medical Officer

CMOP Consolidated Mailorder Outpatient Pharmacy (fills and mails prescriptions)

CMP Contract Management and Performance or Centralized Mail Portal

CMS Centers of Medicare & Medicaid Services

COB Close of Business or Coordination of Benifits

COWC Committee on Waiver and Compromise

CP&E Claims Processing and Eligibility System

CRAM Client Relations Action MAnager

CRM Customer Relationship management system

CS Customer Service

CSR Customer Service Representative

CVWW VA-financed health care benefits to women Vietnam Veterans’ birth children who the Veterans Benefits Administration (VBA) has determined to have a covered birth defect

CXM CXM is the contracted claims processing system provided by SIgnature Performance in Omaha Nebraska

DAPER Document and Process Enabled Repository

DataNet Document repository system

DCDM Document Control and Data Management

DEERS Defense Enrollment Eligibility Reporting System (System to register for TRICARE)

Dependent Spouse or unmarried child (biological, legally adopted, or stepchild under the age of 18, or between the ages of 18 and 23 and attending school, or a child who was permanently and totally disabled before the age of 18)

DFAS Defense Finance and Accounting System

DHA Defense Health Agency

DIC Dependency and Indemnity Compensation

DME Durable Medical Equipment

DOB Date of Birth

DOD Date of Death (or Department of Defense)

DOS Date of Service

DTA Duty to Assist

DTC DIgital Transformation Center

DUNDAS Data visualization tool used by Signature

DX Diagnoses

ECAMS Electronic Claims Adjudication Management System

EDI Electronic Data Interchange

EDI / TAS – Electronic Data Interchange / Transaction Application Suite, System that transfers pharmacy files to and from PBM and CXM.

EEV Eligilibility and Enrollment Verifcation

EFT Electronic Funds Transfer

ELT Executive Leadership Team

EOB Explanation of Benefits form that is sent to Provider and Members upon claim adjudication

EOP Explanation of Payment

EPRS Enterprise Program Reporting System

EQR Equitablr Relief

F2F Face to Face

FACETS Facets is an enterprise-wide core solution that automates claims processing. CXM was developed with FACETS at its core

FM Fiscal Management

FMP Foreign Military Program health care benefits program for U.S. Veterans with VA-rated, service-connected disabilities who are residing or traveling abroad (Canada and Philippines excluded). Under FMP, VA assumes payment responsibility for certain necessary medical services associated with the treatment of those service-connected conditions.

FMS Financial Management System

FO Front Office

FOIA Freedom of Information Act

FSC Financial Services Center

FWA Fraud, Waste and ABuse

GPO Government Print Office

GUI Graphical User Interface

HCFA/1500 Also known as CMS-1500, enables medical physicians to submit health insurance claims for reimbursement

HCPCS Healthcare Common Procedure Coding System

HIPPA Healthcare Insurance Portability and Accountability Act

HRO High Reliability Organization

ICD International Classification of Diseases

IDP Individual Development Plan

IEN Integrated External Networks

Interface Control Document (ICD) Record of all interface information generated for a project.

IVC Office of Integrated Veteran Care (IVC) is a national program office that manages and advocates for Veterans’ and beneficiaries’ access to health care in both VA and community facilities

JCAHO Joint Commission on the Accreditation of Healthcare Organizations

KPI Key Performance Indicator

KSA Knowledge, Skills and Abilities

LOMN Letter of Medical Necessity

MbM Meds by Mail

MCDR Medicare

MPI Master Patient Index

MRA Medicare Remittance Advice

MUMPS Massachusetts General Hospital Utility Multi-Programming System

NCA National Cemetery Administration

NCPDP National Council for Prescription Drug Programs

NDC National Drug Code

NEO New Employee Orientation

NIH National Institute of Health

NPI National Provider Identifier

OCC Office of Community Care. We used to report up to OCC prior to the reorg to Integrated Veteran Care (IVC)

OCLA Office of Congressional & Legislative Affairs

ODBC Open Database Connectivity * Data source for DAPER (Microsoft Access data base with ODBC SQL)

“Office of Community Care (OCC) ” Office formerly responsible for CHAMPVA program

OGC Office of the General Council

OHI Other Health Insurance

OI&T Office of Information & Technology

OIG Office of the Inspector General

OIT Office of Information and Technology

OJT On the Job Training

OOO Out Of Office

OOP Out of Pocket

OPF Official Personnel Folder

OPM Operational Policy Manual

OPTUM Third-party administrator for portions of the community care network (CCN)

OT Overtime or Occupational Therapy

P&T Permanent and Total

P2E Paper to Electronic

PA Program Analyst or Prior Authorization

PACT act “Law that expands VA health care and benefits for Veterans exposed to burn pits and other toxic substances.

The full name of the law is The Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act”

Palliative Care Care provided primarily to relieve symptoms of a disease or condition rather than for curative purposes

PBI Performance Based Interview

PBM Pharmacy Benifit Manager

PBO Pharmacy Benefits Office

PDF Portable Document Format

PDI Program Document Identifier

PDRL Permanent Disability Retired List

PHI Protected Health Information

PHP Partial Hospitalization Program

PI Planning Increment

PII Personally Identifiable Information

PIT Program Integrity Tool

PIV Personal Identify Verification

PMO Program management Office

POM Payment Operations Management * Processes claims for Veteran non-CCN claims, aligned under VHA Finance

POS Place of Service

Pre Auth Pre-authorization (some services must be authorized before the veteran or family member receives treatment)

PT Physical Therapy

PX Procedure Code

QA Quality Assurance

R&R Claim Review & Resolution

RARC Remittance Advice Reason Code

RCI Rapid Cycle Improvement

RFI Request for Information

ROI Release of Information

SB Spina Bifida

Signature Short for SIgnature Performance. A contractor that provides our claims processing system

SLA Service Level Agreement

SME Subject Matter Expert

SOP Standard Operating Procedure

SOR System of Record

SPD Specialty Programs Department

SSA Social Security Administration

SSN Social Security Number

T&A Time and Attendance 🙂

TDRL Temporary Disability Retired List

TMS Training Management System

TOD Tour of Duty

TX Treatment

UBO4 Standard claim form that any institutional provider can use for the billing of inpatient or outpatient medical and mental health claims.

UFR UnFunded Request

UM Utilization Management

User Acceptance Testing (UAT) The last phase of the software testing process.

VA Veterans Administration

VAMC VA Medical Center

VBA Veterans Benefits Administration

VE Voucher Examiner

VES Veterans Evaluation Services or VHA Enrollment System

VFMP Veteran Family Member Program

VHA Veterans Health Administration

VistA Veterans Health Information Systems and Technology Architecture

White House Hotline Electronic transaction that provides claim payment information and documents the EFT (electronic funds transfer). An 835 is sent from insurers to the healthcare provider.

X12 Standards Development Organization. (Medical for us)