Illinois Administrative Code › Title 50 - INSURANCE › Part 2017 - UNIFORM MEDICAL CLAIM AND BILLING FORMS › Section 2017.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
CDT Codes means the current dental terminology prescribed by
				the American Dental Association.
CPT Codes means the current procedural terminology published by
				the American Medical Association.
HCFA means the Health Care Financing Administration of the U.S.
				Department of Health and Human Services.
HCFA Form 1500 means the current health insurance claim form
				published by HCFA, or its revision following the effective date of this Part,
				for use by health care practitioners.
HCPCS Codes means the HCFA's Common Procedure Coding System
				that is based upon the current American Medical Association's (AMA) Physician
				Current Procedural Terminology.
HCPCS Level 1 Codes means the AMA's current CPT codes with the
				exception of anesthesiology services.
HCPCS Level 2 Codes means the codes for physician and
				non-physician services that are not included in current CPT.
Health Care Practitioner means:
A chiropractor licensed under The Medical Practice Act of 1987,
				[225 ILCS 60 ] to treat human ailments without the use of drugs and without
				operative surgery.
A dentist licensed under The Illinois Dental Practice Act, [225
				ILCS 25 ].
A nurse licensed under The Illinois Nursing Act of 1987, [225
				ILCS 65 ].
An occupational therapist licensed under The Illinois
				Occupational Therapy Practice Act, [225 ILCS 75 ].
An optometrist licensed under The Illinois Optometric Practice
				Act of 1987, [225 ILCS 80 ].
A pharmacist licensed under the Pharmacy Practice Act of 1987,
				[225 ILCS 85 ].
A physical therapist licensed under The Illinois Physical
				Therapy Act, [225 ILCS 90 ].
A physician licensed under The Medical Practice Act of 1987,
				[225 ILCS 60] to practice medicine in all of its branches.
A podiatrist licensed under The Podiatric Medical Practice Act
				of 1987, [225 ILCS 100 ].
A psychologist licensed under The Clinical Psychologist
				Licensing Act, [225 ILCS 15 ].
A social worker licensed under The Clinical Social Work and
				Social Work Practice Act, [225 ILCS 20 ].
A speech-language pathologist and/or audiologist licensed under
				The Illinois Speech-Language Pathology and Audiology Practice Act, [225 ILCS
				110 ].
Other Health Care Practitioners licensed by the Illinois
				Department of Professional Regulation.
A supplier of health care services not described herein,
				including but not limited to a physician assistant, nurses aide, or supplier of
				durable medical equipment.
Health Plan means an insurance company, fraternal benefit
				society, dental service plan, limited health service organization,
				pharmaceutical service plan, vision service plan, voluntary health services
				plans, health maintenance organization, workers' compensation insurance, third
				party administrator, third party prescription program administrator, and any
				other entity paying or reimbursing the costs of health care expenses.
ICD-CM Codes means the disease codes in the current
				International Classification of Diseases, clinical modifications published by
				the U.S. Department of Health and Human Services.
Institutional Health Care Provider means:
Ambulatory Surgical Treatment Center licensed under the
				Ambulatory Surgical Treatment Center Act, [210 ILCS 5 ].
Home Health Agency licensed under the Home Health Agency
				Licensing Act, [210 ILCS 55 ].
Hospice licensed under the Hospice Program Licensing Act, [210
				ILCS 60 ].
Hospital licensed under the Hospital Licensing Act, [210 ILCS
				85 ].
Skilled Nursing and Intermediate Care Facility licensed under
				the Nursing Home Care Act, [210 ILCS 45 ].
Trauma Center licensed under the Emergency Medical Services
				(EMS) Systems Act, [210 ILCS 50 ].
Other Institutional Health Care Providers licensed by the
				Illinois Department of Public Health.
J510, J511 or J512 Form means the current uniform dental claim
				form or its revision following the effective date of this Part, approved by the
				American Dental Association for use by dentists.
Medicare means the Health Insurance for the Aged Act, Title
				XVIII of the Social Security Amendments of 1965, as then constituted or later
				amended.
Medical Assistance or Medicaid means Title XIX of the federal
				Social Security Act (
				42 U.S.C.
				1396, et seq.) as then constituted or later
				amended.
Revenue Codes means the current codes established for use by
				institutional health care providers by the National Uniform Billing Committee
				and the Illinois Uniform Billing Committee.
UB92/HCFA Form 1450 means the current health insurance claim
				form, or its revision following the effective date of this Part, developed by
				the National Uniform Billing Committee for use by institutional health care
				providers.