EAP - See Employee Assistance Program

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) - A Medicaid program for recipients younger than 21 that provides screening, vision, hearing, and dental services at intervals that meet recognized standards of medical and dental practices and at other intervals as necessary to determine the existence of physical or mental illnesses or conditions.

ECF - See Extended Care Facility.

Economic Credentialing - The use of economic criteria unrelated to quality of care or professional competency in determining an individual's qualifications for initial or continuing hospital medical staff membership or privileges. Economic credentialing has become a controversial topic involving much concern about ethics; yet, economic credentialing remains the most powerful form of controlling the behavior of doctors. Other forms of control include utilization review, certification, exclusive provider panels and more.

EDI Translator - Used in electronic claims and medical record transmissions, this is a software tool for accepting an EDI transmission and converting the data into another format, or for converting a non-EDI data file into an EDI format for transmission. See also Electronic Data Interchange.

Edits - Criteria that, if unmet, will cause an automated claims processing system to "kick out" a claim for further investigation.

Effective Date - The date on which a policy's coverage of a risk goes into effect.

Election - An enrollee's decision to join or leave a health plan.

Electronic Claim - A digital representation of a medical bill generated by a provider or by the provider's billing agent for submission using telecommunications to a health insurance payer. Most claims are electronically submitted.

Electronic Data Interchange (EDI) - The automated exchange of data and documents in a standardized format. In health care, some common uses of this technology include claims submission and payment, eligibility, and referral authorization. Refers to the exchange of routine business transactions from one computer to another in a standard format, using standard communications protocols.

Electronic Media Claims - A flat file format used to transmit or transport claims, such as the 192-byte UB-92 Institutional EMC format and the 320-byte Professional EMC NSF.

Electronic Medical Record (EMR) - A computer-based record containing health care information. This technology, when fully developed, meets provider needs for real-time data access and evaluation in medical care. Together with clinical workstations and clinical data repository technologies, the EMR provides the mechanism for longitudinal data storage and access. A motivation for healthcare entities to implement this technology derives from the need for medical outcome studies, more efficient care, speedier communication among providers and management of health plans. This record may contain some, but not necessarily all, of the information that is in an individual's paper-based medical record. One goal of HIPAA is to protect identifiable health information as the system moves from a paper-based to an electronic medical record system. See also Computerized Medical Record.

Electronic Remittance Advice - Any of several electronic formats for explaining the payments of health care claims.

Eligible Dependent - Person entitled to receive health benefits from someone else's plan. See also Dependent.

Eligible Employee - Employee who qualifies to receive benefits.

Eligible Expenses - Charges covered under a health plan. See also Covered Services, Approved Services.

Eligible Person - Person who meets the qualifications of a health plan contract.

Elimination Period - Most often used to designate the waiting period in a health insurance policy.

Emergency - Sudden unexpected onset of illness or injury which requires the immediate care and attention of a qualified physician, and which, if not treated immediately, would jeopardize or impair the health of the Member, as determined by the payer's Medical Staff. Significant in that Emergency may be the only acceptable reason for admission without pre-certification.

Emergency Center, Emergi-center - Non-hospital affiliated health facility that provides short-term care for minor medical emergencies or procedures needing immediate treatment; also called urgi-center, urgent center or free standing emergency medical service center.

Emergency Medical Treatment and Labor Act (EMTALA) - An act pertaining to emergency medical situations. EMTALA requires hospitals to provide emergency treatment to individuals, regardless of insurance status and ability to pay.