Critical Vocabulary

Quick Reference

CHS - (Contract Health Service) An IHS program that supplements the health care resources available to eligible American Indian and Alaska Native (AI/AN) people with the purchase of medical care and services that are not available within the IHS direct care system. The IHS purchases basic and specialty health care services from local and community health care providers, including hospital care, physician services, outpatient care, laboratory, dental, radiology, pharmacy, and transportation services such as ground and air ambulance. The CHS program also supports the provision of care in IHS and tribally operated facilities, such as specialty clinics, e.g., orthopedics and neurology, and referrals to specialists for diagnostic services.

The CHS program is administered through 12 IHS Area Offices that consist of 66 IHS-operated Service Units and 84 tribally operated health programs. Although the IHS facilities include two major medical centers, and one tribally medical center, most of the IHS and tribally operated facilities are small rural community hospitals and health centers with basic primary care services. In addition, not all tribes have access to IHS or tribally operated facilities or have limited access. Therefore, those Areas with few or no direct care facilities have a higher reliance on the CHS program to provide the needed health care.

CHS FI - (Contract Health Service Fiscal Intermediary) The CHS FI is the fiscal agent contracted by IHS to provide and implement a system to process CHS medical and dental claims for payment.

CHS638 Files - Data files containing CHS Type 7 statistical records that are sent from the IHS Area Offices to the National Data Repository (i.e. NPIRS). Type 7 statistical records are created when a payment destination of "I" is selected during the creation of a purchase order in CHS/MIS. The names of these files begin with "chs638" and are thus referred to as "chs638" files.

CORE - The Department of Health and Human Services' (DHHS) accounting system to which all third party collections are recorded and reconciled.

EOBR - (Explanation of Benefits Report) is an electronic report produced by the CHS Fiscal Intermediary (FI) that contains line level detail of claim and payment data. The electronic EOBRs are made available to the IHS Area Offices every week. The EOBRs are transmitted from the Area Offices to their respective Service Units/Facilities, which then run a program to update the existing POs in CHS/MIS with the EOBR information.

EPO - (Electronic Purchase Order) is comprised of three record types (i.e. Type 3, 4, and 5 records) originating from the CHS/MIS application and is electronically transmitted from the IHS Area Offices to the CHS Fiscal Intermediary. Only electronic purchase orders for reference codes 323, 324, and 325 are sent to the CHS FI, as these are the only documents the CHS FI processes.

EPOV - (Electronic Purchase Order Verification) is a message the FI sends to the Area Office confirming it received the EPOs.

HCHS/MIS - (Contract Health Service/ Management Information) The Contract Health Service/Management Information System (CHS/MIS) application is a facility-based automated document and fiscal management system for the IHS CHS Program. The CHS/MIS is a fully integrated component of the RPMS and uses the shared data files for patients and vendors. The system generates authorizations for payment for CHS and maintains an up-to-date commitment register for all current obligations and paid CHS funds. CHS/MIS automates the document preparation functions including document generation, data transfer to Referred Care Information Systems (RCIS) module, medical data sent to the Patient Care Component System (PCC), document printing, financial reports sent to and from the health care providers, and the processing of claims/referrals. This application also provides for the communication of authorization information between the National Data Repository (i.e. NPIRS) and the Fiscal Intermediary located in Albuquerque, NM.

IHSCPS - (Indian Health Services Claims Processing System) is the application used by the CHS Fiscal Intermediary (CHS FI) for processing claims submitted by CHS providers for payment.

NPIRS - (National Patient Information Reporting System) The current IHS national repository responsible for generating national level reports including, but not limited to, user pop and workload reports.

PCC - (Patient Care Component) One of the clinical applications in the RPMS software package which provides for entry of visit data which forms the core dataset used by most of the RPMS applications.

RPMS - (Resource Patient Management Information System) is a decentralized automated information system of over 50 integrated software applications. The system is designed to operate on micro- and mini-computers located in IHS or tribal healthcare facilities. Different facilities use different configurations of RPMS applications, depending upon the types of services they provide. That is, the type of services (e.g. dental, laboratory, and inpatient) offered at a site determines the scope of RPMS applications used by the facility.

Type 2 Record - An electronic record that originates from the CHS/MIS application and is transmitted from the IHS Area Offices to CORE (i.e. the IHS finance system). A Type 2 record is a facility-generated document header record (DHR) containing information such as the record type (i.e. inpatient, outpatient, or dental) and financial data for the payment of services.

Type 3 Record - Part of the electronic purchase order record that originates from the CHS/MIS application and is transmitted from the IHS Area Offices to the CHS FI. A Type 3 record contains patient information, including demographics, general health record information, and insurance coverage data.

Type 4 Record - Part of the electronic purchase order record that originates from the CHS/MIS application and is transmitted from the IHS Area Offices to the CHS FI. A Type 4 record contains specific vendor information such as the vendor name, vendor type, and demographic information.

Type 5 Record - Part of the electronic purchase order record that originates from the CHS/MIS application and is transmitted from the IHS Area Offices to the CHS FI. A Type 5 record contains purchase order and patient information, such as purchase order number, health record number, patient name, and date of service.

Type 6 Record - An electronic record that originates from the CHS/MIS application. A Type 6 record contains vendor and accounting information for the Area Office. Type 6 records remain at the Area Office that is performing the CHS consolidation.

Type 7 Record - An electronic record that originates from the CHS/MIS application and is transmitted to the national data repository (i.e. NPIRS). Type 7 records contain statistical information regarding the visit(s) for which the purchase order was approved. Type 7 records are specifically formatted for and transmitted to NPIRS.

638 Site - Congress passed the Indian Self-Determination and Education Assistance Act (Public Law 93-638, as amended) to provide American Indian/Alaska Native (AI/AN) tribes the option of either assuming from the IHS the administration and operation of health services and programs in their communities, or to remain within the IHS administered direct health system. A 638 site refers to tribes operating a service unit have either compacted or contracted using the PL 638 process and may be using the RPMS CHS/MIS application or some other application for entering and maintaining their CHS data.