This glossary defines the accreditation, compliance and program-development terms used across this site. It has 79 entries, in two kinds. IHS terms are defined plainly, as IHS uses them. Terms from federal agencies are quoted from the agency's own page. Terms from every other body, including URAC, NCQA, ACHC, CARF, NABP, AAAHC, The Joint Commission and the other accreditors and standards bodies, are summarized in IHS's own words. Each entry links to its source page. Entries sourced to a page IHS opened give the date it was opened, and the URAC entries are IHS's own description with a plain link to the URAC page.
A quote shows what a federal agency's page says, and a summary or definition for another body gives IHS's reading of the page on the date it was opened. It is not legal advice, and standards change, so open the linked page for the current text. IHS is a consulting firm, not an accrediting body or a law firm, and does not grant or influence an accreditation, certification or licensing decision.
Last reviewed: October 2026.
Jump to: 0-9 | A | B | C | D | E | F | G | H | I | J | L | M | N | P | Q | R | S | T | U | V
0-9
340B Drug Pricing Program
HRSA's Office of Pharmacy Affairs page says:
“Manufacturers participating in Medicaid agree to provide outpatient drugs to covered entities at significantly reduced prices.”
Source: 340B Drug Pricing Program | HRSA (Health Resources and Services Administration (HRSA), Office of Pharmacy Affairs), opened October 2, 2026.
Used on: 340B Program Integrity & Audit Readiness.
A
AAAHC
AAAHC is an accrediting body for ambulatory health care. Its accreditation page says accreditation runs on a three-year cycle and that AAAHC supports accredited organizations throughout it.
Source: Accreditation | AAAHC (AAAHC), page opened October 3, 2026.
Used on: AAAHC Ambulatory Accreditation Consulting.
AABB
AABB (the Association for the Advancement of Blood & Biotherapies) is a nonprofit with international reach. Its members are people and institutions working in transfusion medicine and biotherapies, and it runs a standards and accreditation program.
Source: About AABB - Association for the Advancement of Blood & Biotherapies (AABB), page opened October 3, 2026.
Used on: AABB Transfusion Service Accreditation Consulting.
AAHRPP
AAHRPP is the Association for the Accreditation of Human Research Protection Programs. It is an independent nonprofit that accredits the programs organizations use to protect people in research, and its process is voluntary and draws on peer review.
Source: Our Mission and History (AAHRPP), page opened October 3, 2026.
Used on: AAHRPP Clinical Research & IRB Accreditation Consulting.
Accreditation
In IHS's usage, accreditation is an accrediting body's formal finding, after its review, that an organization's operations meet that body's standards.
URAC page: Accreditation FAQs - URAC.
Used on: Healthcare Accreditation & Certification Consulting.
Accreditation consulting
IHS term, defined as IHS uses it.
Accreditation consulting is the first of IHS's three practice lines. IHS helps an organization prepare for an accreditation, certification or recognition decision made by an accrediting body such as URAC, NABP or ACHC. IHS drafts and reviews; the accrediting body makes the decision.
Used on: Healthcare Accreditation & Certification Consulting.
Accrediting organization (CMS)
CMS's page on accrediting organizations says:
“CMS approves certain national AOs to evaluate compliance with Medicare conditions, allowing providers to participate in the Medicare program through participation with a CMS-approved AO.”
Source: Accrediting Organizations (AOs) | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
Used on: CMS Deeming Authority Application Consulting for Accrediting Organizations.
AccreditNet
AccreditNet is URAC's online platform. In IHS's experience, URAC opens it to an applicant after the contract is signed and URAC's fee is paid, and the applicant submits its documents for desktop review through it.
URAC page: Accreditation Process - URAC.
Used on: URAC Specialty Pharmacy Accreditation Consulting; URAC Health Care Management Certification Consulting.
ACHC
ACHC is an accrediting body. Its Our Story page traces it to a 2020 merger of two accreditation organizations, a merger CMS approved.
Source: Our Story | ACHC.ORG (ACHC), page opened October 3, 2026.
ACHC separates the two by scope. Its Accreditation 101 page applies certification to a single program, with telehealth, stroke and wound care as its examples, while accreditation looks at the organization overall.
Source: Accreditation 101 | ACHC.ORG (ACHC), page opened October 3, 2026.
Used on: Home Health & Hospice Accreditation Consulting — CHAP, ACHC, and Joint Commission; ACHC Home Health Accreditation Consulting.
B
Bespoke build
IHS term, defined as IHS uses it.
A bespoke build is an engagement in which IHS drafts documents and program content for your organization. It runs through six phases: a gap assessment, questionnaires, document and evidence mapping, drafting, mock review, and readiness support. Your organization supplies the facts, approves and adopts the result, and submits it. The written scope sets which phases apply.
Used on: How IHS Works.
Breach notification (HIPAA)
HHS's Breach Notification Rule page says:
“The HIPAA Breach Notification Rule, 45 CFR §§ 164.400-414, requires HIPAA covered entities and their business associates to provide notification following a breach of unsecured protected health information.”
Source: Breach Notification Rule | HHS.gov (U.S. Department of Health and Human Services (HHS), Office for Civil Rights), opened October 2, 2026.
The same HHS page says:
“A breach is, generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information.”
Source: Breach Notification Rule | HHS.gov (U.S. Department of Health and Human Services (HHS), Office for Civil Rights), opened October 2, 2026.
Used on: 42 CFR Part 2 Compliance Consulting for Substance Use Disorder Records; AI Regulation in Healthcare: Federal & State Requirements.
Business associate (HIPAA)
HHS's guidance on business associates says:
“Generally, business associates are persons, other than a workforce member of a covered entity, that are engaged by a covered entity to carry out certain health care activities and functions or to provide certain services that involve the use or disclosure of PHI.”
Source: Business Associates | HHS.gov (U.S. Department of Health and Human Services (HHS), Office for Civil Rights), opened October 2, 2026.
Used on: Policy and Procedure Architecture for Multiple Standards.
C
CAHPS
AHRQ's page on CAHPS says:
“CAHPS surveys enable organizations to systematically ask patients about their experiences with healthcare in various outpatient and inpatient settings and generate information that can be compared across departments and facilities, over time, and across entities.”
Source: About the CAHPS Program and Surveys | Agency for Healthcare Research and Quality (Agency for Healthcare Research and Quality (AHRQ)), opened October 2, 2026.
Used on: URAC Medicare Advantage Organization Accreditation Consulting; URAC Medicaid Health Plan Accreditation — Frequently Asked Questions.
CARF
CARF International is a nonprofit. Its About page lists aging services, behavioral health and medical rehabilitation among the areas it accredits, and reports more than 9,600 service providers in its reach.
Source: About CARF - CARF International (CARF), page opened October 3, 2026.
Used on: CARF Behavioral Health & Addiction Treatment Accreditation Consulting.
Case management accreditation (URAC)
URAC's accreditation for organizations that provide case management. IHS prepares case management programs for URAC's desktop review and validation review.
URAC page: Case Management Accreditation - URAC.
Used on: URAC Case Management and Utilization Management Accreditation Consulting; CARF Behavioral Health Case Management Accreditation Consulting.
Certified IDR entity
CMS's page on payment disputes says:
“Disputing parties have the option to choose a third-party entity, known as a certified IDR entity, from a list of certified organizations to resolve their dispute.”
Source: About Independent Dispute Resolution | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
45 CFR 149.510(e)(1)(i), in the October 1, 2025 edition of the CFR on govinfo.gov (the current eCFR may show later amendments), says:
“An IDR entity must meet the standards described in this paragraph (e) and be certified by the Secretary, jointly with the Secretaries of Labor and the Treasury …”
Source: 45 CFR 149.510, October 1, 2025 edition (U.S. Government Publishing Office, govinfo.gov), opened October 2, 2026.
Used on: Federal IDR Entity Certification Consulting.
Compliance services
IHS term, defined as IHS uses it.
Compliance services are consulting work that helps a healthcare organization build, test and maintain the programs that keep it within the laws, regulations and contract terms that apply to it. They are IHS's second practice line.
Used on: Healthcare Compliance Consulting Services.
Conditional accreditation (URAC)
IHS uses this term for a URAC decision short of full accreditation that leaves deficiencies for the organization to correct. The status names that apply are in your URAC decision letter.
URAC page: Accreditation Process - URAC.
Used on: URAC PBM Accreditation Consulting.
Covered entity (HIPAA)
HHS's guidance on business associates says the HIPAA rules apply to:
“… covered entities--health plans, health care clearinghouses, and health care providers who transmit health information in electronic form in connection with a covered transaction …”
Source: Business Associates | HHS.gov (U.S. Department of Health and Human Services (HHS), Office for Civil Rights), opened October 2, 2026.
Used on: 340B HRSA Audit Preparation Guide; 42 CFR Part 2 Compliance Consulting for Substance Use Disorder Records.
Credentialing committee (NCQA)
NCQA's credentialing standards page includes a credentialing committee in the elements it describes for organizations that run credentialing. IHS uses the term for the standing group that weighs a practitioner's file when an organization credentials or recredentials.
Source: Standards - Credentialing - NCQA (NCQA), page opened October 3, 2026.
Used on: Healthcare Credentialing Program Design & Implementation; URAC Dental Network Accreditation Consulting.
Credentialing (NCQA)
IHS uses credentialing to mean verifying that a clinician holds the licenses, training and record needed to practice. NCQA's Credentialing page presents credentialing as a patient-safety safeguard.
Source: Credentialing - NCQA (NCQA), page opened October 3, 2026.
Used on: Healthcare Credentialing Program Design & Implementation.
CVO (credentialing verification organization)
A CVO is an organization that verifies practitioners' credentials for its clients. NCQA's guide to its credentialing programs describes CVOs and their role in credentialing; the guide is linked below, and IHS uses the term as defined above.
Source: A Comprehensive Guide to NCQA Credentialing Programs - NCQA (NCQA), page opened October 3, 2026.
NCQA's Credentialing page lists Credentialing Certification as one of its programs, aimed at credentials verification organizations.
Source: Credentialing - NCQA (NCQA), page opened October 3, 2026.
Used on: Healthcare Credentialing Program Design & Implementation.
D
Deemed status and deeming authority
CMS's page on accrediting organizations says:
“CMS grants deemed status when CMS-approved AOs: Have accreditation standards that meet or exceed those of Medicare, and Demonstrate survey processes comparable to those of SAs.”
Source: Accrediting Organizations (AOs) | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
The same CMS page says:
“Deeming authority is granted by CMS after a formal review of an AO’s standards and survey processes.”
Source: Accrediting Organizations (AOs) | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
Used on: CMS Deeming Authority Application Consulting for Accrediting Organizations; AAAHC Ambulatory Accreditation Consulting.
Delegation oversight (URAC Health Utilization Management)
Delegation oversight is the work an organization does to monitor functions it has handed to another organization, such as a utilization management vendor. IHS builds delegation oversight programs to the URAC standards that apply.
URAC page: Health Utilization Management Accreditation - URAC.
Used on: URAC Dental Network Accreditation Consulting; Healthcare Credentialing Program Design & Implementation.
Desktop review (URAC)
In IHS's experience, the desktop review begins once the applicant submits its documents through AccreditNet. URAC's reviewers rate the documents against each standard and return their findings as a Request for Information.
URAC page: Accreditation Process - URAC.
See also: Mock Desktop Review.
Used on: URAC Pharmacy Services Accreditation Consulting.
DNV healthcare accreditation
DNV is an accreditation and certification body. Its healthcare page lists NIAHO accreditation for hospitals and ambulatory surgical centers, specialty certifications such as stroke care, and training, and says DNV tailors its approach to each organization.
Source: Healthcare Certification and Hospital Accreditation services by DNV (DNV), page opened October 3, 2026.
Used on: DNV Healthcare Accreditation & ISO 9001 Integration Consulting.
Document and evidence mapping
IHS term, defined as IHS uses it.
The third phase of a bespoke build. IHS builds a crosswalk from each requirement to the policy, form, log or record that answers it.
Used on: How IHS Works; Policy and Procedure Architecture for Multiple Standards.
Drafting
IHS term, defined as IHS uses it.
The fourth phase of a bespoke build. IHS drafts policies, procedures, forms and program content for your organization, with approval lines for your reviewers and open slots where only you can supply the answer. Clinical content is approved by your licensed clinicians.
Used on: How IHS Works.
E
Exclusion screening (OIG)
OIG's exclusions page says:
“To avoid CMP liability, health care entities should routinely check the list to ensure that new hires and current employees are not on it.”
Source: Exclusions Program | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services (HHS Office of Inspector General), opened October 2, 2026.
Used on: Exclusion Screening Program Consulting: OIG LEIE, SAM.gov and State Medicaid Lists.
F
FACT
FACT is a nonprofit accrediting body for cellular therapy programs. Experts in the field founded it in 1995, it incorporated as a nonprofit in 1996, and it serves as the inspection and accreditation arm of two professional societies, ASTCT and ISCT.
Source: The FACT Story (FACT), page opened October 3, 2026.
FACT's home page describes FACT Accreditation as a mark of meeting FACT Standards for cellular therapy.
Source: Home Page (FACT), page opened October 3, 2026.
Used on: FACT Cellular Therapy & CAR-T Accreditation Consulting.
First-tier, downstream and related entities (FDR)
42 CFR 422.500, in the October 1, 2025 edition of the CFR on govinfo.gov (the current eCFR may show later amendments), says:
“First tier entity means any party that enters into an acceptable written arrangement with an MA organization or contract applicant to provide administrative services or health care services for a Medicare eligible individual.”
Source: 42 CFR 422.500 Scope and definitions, October 1, 2025 edition (U.S. Government Publishing Office, govinfo.gov), opened October 2, 2026.
The same section says:
“Downstream entity means any party that enters into an acceptable written arrangement below the level of the arrangement between an MA organization (or contract applicant) and a first tier entity.”
Source: 42 CFR 422.500 Scope and definitions, October 1, 2025 edition (U.S. Government Publishing Office, govinfo.gov), opened October 2, 2026.
Used on: Health Plan FDR Compliance Readiness Consulting; Medicare Advantage and Part D Compliance Program and FDR Oversight Consulting.
G
Gap analysis
IHS term, defined as IHS uses it.
IHS pages use gap analysis and gap assessment for the same step. See Gap assessment.
See also: Gap assessment.
Used on: How IHS Works; URAC Dental Network Accreditation Consulting.
Gap assessment
IHS term, defined as IHS uses it.
The first phase of a bespoke build. A series of calls walks everyone involved through each standard, and IHS compares what you have against the governing text and records the findings.
Used on: How IHS Works; Healthcare Regulatory Readiness & Gap Assessment Services.
Governing text
IHS term, defined as IHS uses it.
The standard, regulation or contract that requires or shapes a program, in the version in force. IHS compares your documents against the governing text.
Used on: Healthcare program development consulting; How IHS Works.
H
Health network accreditation (URAC)
URAC's accreditation for organizations that build and manage provider networks. IHS prepares network programs and their evidence for URAC's reviews.
URAC page: Health Network Accreditation Program | URAC.
Used on: URAC Health Network Accreditation.
Health plan accreditation
URAC offers Health Plan Accreditation to health plans.
URAC page: Health Plan Accreditation Program | URAC.
NCQA offers Health Plan Accreditation to health plans; the program page is linked below.
Source: Health Plan Accreditation - NCQA (NCQA), page opened October 3, 2026.
Used on: URAC Health Plan Accreditation Consulting; URAC Marketplace Health Plan Accreditation.
HEDIS
HEDIS stands for Healthcare Effectiveness Data and Information Set. It is NCQA's set of performance measures, and NCQA's HEDIS page gives its reach as more than 235 million enrolled members.
Source: HEDIS - NCQA (NCQA), page opened October 3, 2026.
Used on: URAC Health Plan Accreditation Consulting; URAC Medicare Advantage Organization Accreditation Consulting.
HIPAA Security Rule
HHS's Security Rule page says:
“The HIPAA Security Rule establishes national standards to protect individuals' electronic protected health information that is created, received, used, or maintained by a covered entity or its business associate.”
Source: The Security Rule | HHS.gov (U.S. Department of Health and Human Services (HHS), Office for Civil Rights), opened October 2, 2026.
HHS's guidance on risk analysis says:
“Conducting a risk analysis is the first step in identifying and implementing safeguards that comply with and carry out the standards and implementation specifications in the Security Rule.”
Source: Guidance on Risk Analysis | HHS.gov (U.S. Department of Health and Human Services (HHS), Office for Civil Rights), opened October 2, 2026.
Used on: Policy and Procedure Architecture for Multiple Standards; Security Compliance Foundations (HITRUST) for Healthcare Organizations.
HITRUST
HITRUST is a cybersecurity assurance organization. It offers three assessments and certifications, called e1, i1 and r2, matched to an organization's size and risk. All three build on one control framework, so work from a smaller assessment can carry into a larger one.
Source: Cybersecurity Compliance Certifications and Assessments | HITRUST (HITRUST), page opened October 3, 2026.
Used on: Security Compliance Foundations (HITRUST) for Healthcare Organizations.
I
Independent dispute resolution (IDR)
CMS's page on payment disputes says:
“The No Surprises Act created new protections against out-of-network balance billing and established a new process called independent dispute resolution (IDR), which is managed by the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury (the Departments).”
Source: About Independent Dispute Resolution | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
Used on: URAC Independent Dispute Resolution (IDR) Designation; Federal IDR Entity Certification Consulting.
Independent review organization (IRO)
An independent review organization decides disputed coverage questions, such as medical necessity, for health plans and others through independent clinical review. URAC accredits IROs, and IHS prepares IROs for URAC's reviews.
URAC page: Independent Review Organization (IRO) Accreditation | URAC.
Used on: URAC Independent Review Organization (IRO) Accreditation.
ISO 9001
ISO 9001 is the international standard for quality management systems, published by the International Organization for Standardization (ISO). ISO sells the standard through its store, and this site does not reproduce its text. ISO's page on the ISO 9000 family also lists sector-specific standards built on ISO 9001.
Source: ISO - ISO 9000 family — Quality management (International Organization for Standardization (ISO)), page opened October 3, 2026.
Used on: Quality Management System Design to ISO 9001:2026; DNV Healthcare Accreditation & ISO 9001 Integration Consulting.
J
The Joint Commission
From The Joint Commission's About page, in IHS words:
The page describes The Joint Commission as an organization that works on health care quality and patient safety at a global level, across the continuum of care.
Source: About Us | Joint Commission (The Joint Commission), opened October 3, 2026.
From The Joint Commission's accreditation page, in IHS words:
The page describes accreditation as a review an organization takes up to measure itself and get better, in service of safe, high-quality care for patients. It adds that accreditation is awarded after a successful on-site survey.
Source: Accreditation | Joint Commission (The Joint Commission), opened October 3, 2026.
Used on: Stroke Center Certification Readiness Consulting (Joint Commission, DNV, ACHC).
L
LEIE (List of Excluded Individuals/Entities)
OIG's exclusions FAQ says:
“OIG's LEIE provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs.”
Source: Exclusions FAQs | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services (HHS Office of Inspector General), opened October 2, 2026.
OIG's exclusions page says:
“Those that are excluded can receive no payment from Federal health care programs for any items or services they furnish, order, or prescribe.”
Source: Exclusions Program | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services (HHS Office of Inspector General), opened October 2, 2026.
Used on: Exclusion Screening Program Consulting: OIG LEIE, SAM.gov and State Medicaid Lists.
M
Medicare Advantage
CMS's glossary says:
“A Medicare program that gives you more choices among health plans.”
Source: Glossary | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
Used on: URAC Medicare Advantage Organization Accreditation Consulting.
Medicare Advantage and Part D compliance program
CMS's compliance program page says:
“Federal regulations at 42 C.F.R. §§422.503 and 423.504 specify the requirements for Medicare Plans to implement an effective Compliance Program.”
Source: Compliance Program Policy and Guidance | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
For Medicare Advantage, 42 CFR 422.503(b)(4)(vi), in the October 1, 2025 edition of the CFR on govinfo.gov (the current eCFR may show later amendments), says:
“Adopt and implement an effective compliance program, which must include measures that prevent, detect, and correct non-compliance with CMS’ program requirements as well as measures that prevent, detect, and correct fraud, waste, and abuse.”
Source: 42 CFR 422.503 General provisions, October 1, 2025 edition (U.S. Government Publishing Office, govinfo.gov), opened October 2, 2026.
Used on: Medicare Advantage and Part D Compliance Program and FDR Oversight Consulting; Healthcare Compliance Consulting Services.
Mock Desktop Review
IHS term, defined as IHS uses it.
IHS reads the documents you plan to submit against the governing text, as a reviewer reading them would.
See also: Desktop review (URAC).
Used on: How IHS Works; URAC Pharmacy Services Accreditation Consulting.
Mock review
IHS term, defined as IHS uses it.
IHS's umbrella term for the fifth phase of a bespoke build. Depending on scope, it is a Mock Desktop Review of your documents, a Mock Validation Review of whether practice matches policy, or both.
See also: Mock Desktop Review, Mock Validation Review.
Used on: How IHS Works; URAC Pharmacy Services Accreditation Consulting.
Mock survey
IHS term, defined as IHS uses it.
A practice review run before an accreditor's real survey, so gaps surface first. IHS pages use the term for surveys by accrediting bodies such as ACHC and CARF. For URAC work, the steps are called a Mock Desktop Review and a Mock Validation Review.
See also: Mock Desktop Review, Mock Validation Review.
Used on: ACHC Home Health Accreditation Consulting; CARF Inpatient Behavioral Health Treatment Accreditation Consulting.
Mock Validation Review
IHS term, defined as IHS uses it.
IHS tests whether your staff's practice matches what your policies say, as a validation reviewer would.
See also: Validation review (URAC).
Used on: How IHS Works; URAC PBM Accreditation Consulting.
Monitoring validation review (URAC)
In IHS's usage, a monitoring validation review is a review URAC holds during the accreditation term to check that the organization still meets the standards.
URAC page: Accreditation FAQs - URAC.
Used on: URAC Independent Review Organization (IRO) Accreditation; URAC Health Plan Accreditation Consulting.
Multi-accreditation requirements register
IHS term, defined as IHS uses it.
A controlled list that links each requirement from every accreditor and regulator an organization answers to with one policy and one evidence owner, so a single policy set can be kept current across all of them. This is an IHS term.
Used on: Multi-accreditation requirements register and evidence maintenance.
N
NABP
NABP is the National Association of Boards of Pharmacy, an association of pharmacy boards. Its About page lists pharmacy accreditation and inspection programs among its services.
Source: About Us | National Association of Boards of Pharmacy (NABP), page opened October 3, 2026.
Used on: NABP Pharmacy Accreditation Consulting.
Named contact
IHS term, defined as IHS uses it.
The person at your organization who files and sends documents to an accreditor or regulator, under your organization's name. IHS drafts the text; the named contact sends it.
Used on: How IHS Works.
National Practitioner Data Bank (NPDB)
The NPDB's About page says:
“The National Practitioner Data Bank (NPDB) is a web-based repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers.”
Source: The NPDB - About Us (Health Resources and Services Administration (HRSA), NPDB), opened October 2, 2026.
Used on: Healthcare Credentialing Program Design & Implementation; Health Center Credentialing and Medicaid Enrollment Strategy.
NCCHC
NCCHC is the National Commission on Correctional Health Care, a nonprofit that works on the care people receive in correctional settings. Its site lists facility accreditation and separate jail, prison and juvenile standards.
Source: About Us | National Commission on Correctional Health Care (NCCHC), page opened October 3, 2026.
Used on: NCCHC Correctional Healthcare Accreditation Consulting.
NCQA
NCQA's About page states a mission centered on health care quality.
Source: About NCQA - NCQA (NCQA), page opened October 3, 2026.
Used on: Healthcare Credentialing Program Design & Implementation.
P
PCMH (patient-centered medical home)
PCMH is short for patient-centered medical home. NCQA runs a recognition program for it, and NCQA's PCMH page, linked below, gives NCQA's own description of the model.
Source: Patient-Centered Medical Home (PCMH) - NCQA (NCQA), page opened October 3, 2026.
Used on: Healthcare Accreditation & Certification Consulting; URAC Transitions of Care Designation.
Pharmacy benefit management accreditation (URAC)
URAC's accreditation for pharmacy benefit managers. IHS prepares PBMs for URAC's desktop review and validation review.
URAC page: Pharmacy Benefit Management Accreditation Program | URAC.
Used on: URAC PBM Accreditation Consulting.
Policy and procedure architecture
IHS term, defined as IHS uses it.
The design of how an organization's policies, procedures and forms are structured, numbered, owned, approved, reviewed and retired, so that one maintained set can be mapped to every standard the organization is held to.
Used on: Policy and Procedure Architecture for Multiple Standards.
Primary source verification
Primary source verification means confirming a practitioner's credential with the body that issued it. NCQA's credentialing standards page also addresses verification through sources other than the issuer; see that page for the routes it lists.
Source: Standards - Credentialing - NCQA (NCQA), page opened October 3, 2026.
Used on: Healthcare Credentialing Program Design & Implementation.
Prior authorization (Medicare fee-for-service)
CMS's page on Medicare fee-for-service prior authorization and pre-claim review initiatives says:
“Under prior authorization, the provider or supplier submits the prior authorization request and receives the decision before services are rendered.”
Source: Prior Authorization and Pre-Claim Review Initiatives | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
This entry describes CMS's Medicare fee-for-service initiatives only.
Used on: CMS-0057-F Prior Authorization Compliance Consulting.
Program development
IHS term, defined as IHS uses it.
Program development is building a healthcare program from scratch under a standard, regulation or contract. It produces the policies, procedures, workflows, quality system and governance that the program did not have before. It is IHS's third practice line.
Used on: Healthcare program development consulting.
Protected health information (PHI)
HHS's summary of the HIPAA Privacy Rule says:
“The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."”
Source: Summary of the HIPAA Privacy Rule | HHS.gov (U.S. Department of Health and Human Services (HHS), Office for Civil Rights), opened October 2, 2026.
Used on: Healthcare AI Governance & Algorithmic Compliance Consulting.
Provisional accreditation (URAC)
In IHS's experience, URAC grants Provisional accreditation on the desktop review alone. After the Request for Information is resolved, the reviewers take the application to URAC's Accreditation Committee, which grants Provisional accreditation. It lasts 18 months.
URAC page: Accreditation FAQs - URAC.
Used on: URAC Specialty Pharmacy Accreditation Consulting.
Q
Questionnaires
IHS term, defined as IHS uses it.
The second phase of a bespoke build. IHS sends questions that collect your operating facts, and your organization answers them.
Used on: How IHS Works.
R
Readiness support
IHS term, defined as IHS uses it.
The sixth phase of a bespoke build. IHS drafts the application or survey packet text, drafts correspondence, and drafts responses to findings. Your organization files and sends them.
Used on: How IHS Works.
Remote patient monitoring
CMS's remote patient monitoring page says:
“Remote patient monitoring allows a patient to collect their own health data, like blood pressure, weight, and glucose levels, using a connected medical device that automatically transmits the data to their health care provider.”
Source: Remote Patient Monitoring | CMS (Centers for Medicare & Medicaid Services (CMS)), opened October 2, 2026.
Used on: RPM and Telehealth Program Build Consulting; Remote Patient Monitoring (RPM) Compliance Consulting.
Request for Information (RFI)
In IHS's experience, URAC returns its desktop review findings as a Request for Information about a month after the documents are submitted. The applicant answers with added or revised documents, which usually takes a couple of weeks.
URAC page: Accreditation Process - URAC.
Used on: URAC Health Plan Accreditation FAQ — Your Questions Answered; ACHC Home Health Accreditation Consulting.
S
Specialty pharmacy accreditation (URAC)
URAC's accreditation for specialty pharmacies. IHS drafts the pharmacy's policies, including its patient management program, for URAC's reviews.
URAC page: Specialty Pharmacy Accreditation Program & Standards | URAC.
Used on: URAC Specialty Pharmacy Accreditation Consulting; URAC Specialty Pharmacy Services Accreditation Consulting.
Standard-by-Standard Review
IHS term, defined as IHS uses it.
An educational series of calls that walks the people involved through each standard, so they learn what it asks for and what you must be able to show.
Used on: How IHS Works; Healthcare Credentialing Program Design & Implementation.
Standards crosswalk
IHS term, defined as IHS uses it.
A table that links each requirement in a standard to the policy, form, log or record that answers it. IHS builds one during document and evidence mapping.
See also: Document and evidence mapping.
Used on: Policy and Procedure Architecture for Multiple Standards; How IHS Works.
Standards development
IHS term, defined as IHS uses it.
Building a set of standards or program rules from the ground up for a client, as distinct from helping a client meet an existing standard. IHS includes it within its program development practice line.
Used on: Healthcare Accreditation Consulting Services; About IHS.
Starfinch
IHS term, defined as IHS uses it.
The software IHS uses to hold standards, documents and citations together.
Used on: Starfinch©; How IHS Works.
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Telehealth
HHS's telehealth.hhs.gov page says:
“Telehealth — sometimes called telemedicine — lets you see your health care provider without going to their office.”
Source: Why use telehealth? | Telehealth.HHS.gov (U.S. Department of Health and Human Services (HHS), Telehealth.HHS.gov), opened October 2, 2026.
Used on: URAC Telehealth Accreditation Consulting.
Telehealth accreditation (URAC)
URAC's accreditation for organizations that deliver care by telehealth. IHS prepares telehealth programs for URAC's desktop review and validation review.
URAC page: Telehealth Accreditation Program | URAC.
Used on: URAC Telehealth Accreditation Consulting.
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URAC
URAC is an accrediting body for health care organizations, including health plans, pharmacies, utilization management organizations and networks. Thomas G. Goddard, JD, PhD, IHS's founder, is URAC's former Chief Operating Officer and General Counsel.
URAC page: About Us - URAC.
Used on: Healthcare Accreditation & Certification Consulting; URAC Health Plan Accreditation Consulting.
Utilization management
IHS uses utilization management for a health plan's review of whether requested care is appropriate. NCQA's Utilization Management Accreditation page is linked below.
Source: Utilization Management - NCQA (NCQA), page opened October 3, 2026.
Used on: URAC Case Management and Utilization Management Accreditation Consulting; UM and Case Management Program Build Consulting.
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Validation review (URAC)
In IHS's experience, the validation review is URAC's check that the organization operates the way its desktop review documents say it does. It follows the desktop review.
URAC page: Accreditation Process - URAC.
See also: Mock Validation Review.
Used on: URAC PBM Accreditation Consulting; URAC Workers' Compensation Utilization Management Accreditation.