As used in this chapter, unless the context otherwise requires:
1. "Board" means the community health management information system governing board established in section 144C.4.
2. "Commissioner" means the commissioner of insurance.
3. "Community health management information system" or "system" means an integrated electronic health management information system for transmittal and selected storage of data related to transactions and other health care-related information.
4. "Consumer" means an employer, labor union, an individual representing an employer or labor union, a representative of state government, or a member of the general public. "Consumer" does not include a provider, payor, an employee of a provider or payor, or other person with a financial interest in the provision of or payment for health care.
5. "Data repository" means the community health management information system data repository for the storage and transmittal of data related to transactions and other health care-related information.
6. "Division" means the insurance division.
7. "Interface" means the ability to communicate electronically according to standards and communication formats established by the board.
8. "Outcomes measurement" means a method established by the board for determining the quality of health care provided to consumers.
9. "Payor" means a person who provides for the payment of health care benefits including a third party administrator subject to chapter 513A; an insurer issuing a group accident or sickness insurance policy on an expense incurred basis; a person issuing a group hospital or medical service contract pursuant to chapter 509, 514, or 514A; a group health maintenance organization operating pursuant to chapter 514B; or a self-insured plan.
10. "Provider" means a hospital licensed pursuant to chapter 135B; a health care facility licensed pursuant to chapter 135C, 135G, or 135H; a hospice program certified under Title XVIII or XIX of the federal Social Security Act or a hospice program licensed under chapter 135J; a health-related professional licensed under chapters 147 through 154, and chapters 154B and 155A; and a home care aide services program certified under Title XVIII or XIX of the federal Social Security Act or a home care aide services program under contract with the Iowa department of public health.
11. "Self-insured plan" means a plan which retains the risk of loss or payment of claims related to the payment of accident and health benefits or medical, surgical, or hospital benefits as determined by the person establishing such plan.
12. "Severity of illness" means the clinical measurement of the relative medical condition of a patient.
13. "Severity of illness risk adjustment" means a reporting methodology used to adjust various statistics based upon severity of illness which is approved by the board.
14. "Transaction" means an electronic claim, encounter, or other electronic message as defined by the board pursuant to section 144C.4.
15. "Transaction network" means an electronic network which the board has certified and with which the board has entered into an agreement for receiving and transmitting data as provided in this chapter between health care providers, payors, the data repository, and any other persons the board deems necessary.
94 Acts, ch 1033, §3
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