Docs / Reference
Glossary
| Term | Meaning |
|---|---|
| ADR | Additional Documentation Request — a reviewer’s demand for the records behind a claim; strict response deadline |
| AHI / RDI | Apnea–Hypopnea Index / Respiratory Disturbance Index — sleep-study severity values; PAP qualification keys on them |
| BAA | Business Associate Agreement — the HIPAA contract required before a vendor touches PHI |
| DME MAC | The Medicare Administrative Contractor processing DME claims for your jurisdiction — Noridian (JA, JD) or CGS (JB, JC) |
| F2F | Face-to-face encounter — the in-person evaluation Medicare requires behind an equipment order |
| HCPCS | The equipment coding system (E0601 = CPAP, E1390 = oxygen concentrator, …) — what you declare on a case |
| Jurisdiction | Which of the four DME regions (A–D) a claim belongs to, by the beneficiary’s address |
| LCD | Local Coverage Determination — the MACs’ published coverage criteria per equipment category; the source of most checklist rules |
| LON | Length of Need — months of expected use (99 = lifetime). No longer a required element of the SWO since the 2020 order rule; AffirmDME still asks for it on capped-rental items because the PA request and rental tracking need the expected duration |
| MBI | Medicare Beneficiary Identifier — the 11-character ID on the Medicare card |
| NPI | National Provider Identifier — the prescriber’s 10-digit ID, validated against NPPES |
| NPPES | The CMS registry of NPIs — what AffirmDME validates prescriber NPIs against |
| PA | Prior authorization — pre-delivery approval; mandatory for some items (PMDs), documentation-review for the rest |
| PTAN | Provider Transaction Access Number — your Medicare billing number, per location |
| SWO | Standard Written Order — the required order format since 2020 (42 CFR 410.38(d)) |
| UTN | Unique Tracking Number — the MAC’s identifier for a PA decision; required on resubmissions and appeals |
For what Medicare actually requires per equipment category, see the requirement guides.