Adjustments can be defined as an additional payment or a reduction in payment at the line, claim, or provider level.
Aid to Families with Dependent Children
Blue Cross/Blue Shield
Bureau of Care Management and Medical Support
Bureau of Long Term Care and Behavioral Health Services
The Bureau of Long Term Care and Behavioral Health Services is responsible for all long term care programs, both institutional and community based, for the elderly and other special needs populations .
Centers for Medicare & Medicaid Services
The former health care program established to provide health coverage for active duty family members and retirees and their family members. TRICARE was organized as a separate office under the Assistant Secretary of Defense and replaced CHAMPUS in 1994. Benefits covered under CHAMPUS are now covered under TRICARE.
Claim Control Number
A person or business which provides goods or services to another entity under terms specified in a contract.
Current Procedural Terminology
Department of Health and Environmental Control
The South Carolina Department of Health and Environmental Control (DHEC) is the state agency charged with protecting public health, coastal resources, and the state’s land, air and water quality as authorized under multiple state and federal laws. Approximately 3,800 full-time DHEC employees around the state provide vital healthcare and other direct services, monitor pollution, coordinate disease control, carry out the agency’s inspection and regulatory responsibilities, respond to environmental emergencies, and protect public health and the environment in numerous other ways.
Department of Health and Human Services
EFT (Electronic Funds Transfer) is the legal contract which covers any transfer of funds that is initiated by electronic means, such as an electronic terminal, telephone, computer, ATM, etc.
Electronic Data Interchange
(EDI) is the structured transmission of data between
Electronic Remittance Advice
Explanation of Benefits
File Transfer Protocol
An instance in which deliberate deceit is used by a provider to obtain payment for services not actually delivered or received, or by a beneficiary to claim program eligibility.
Freedom of Information Act
Gap Assistance Pharmacy Program for Seniors
A grievance is a written complaint or concern, on a non-appealable issue, from a Medicaid beneficiary or a provider.
Health Insurance Portability and Accountability Act
Health Maintenance Organization
Healthy Connections Kids
Health Connections Kids is a health insurance program for uninsured children. SC Healthy Connections Kids (SCHIP)
Learning Management System
Low Income Families
Management and Administration Reporting System
Mechanized Claims Processing
Medicaid Insurance Verification Service
Moodle (abbreviation for Modular Object-Oriented Dynamic Learning Environment) is a free and open-source e-learning software platform, also known as a Course Management System, Learning Management System, or Virtual Learning Environment (VLE).
National Provider Identification
Notice of Privacy Practices
Optional State Supplementation
The OSS program is designed to provide a monthly payment on behalf of eligible aged, blind or disabled persons who need assistance paying the licensed/enrolled Community Residential Care Facilities where they live.
Primary Care Physician
Protected Health Information
South Carolina Department of Health and Human Services
State Children’s Health Insurance Program
Surveillance Utilization Review Subsystem
Tax Equity and Fiscal Responsibility Act
Third Party Liability
Trading Partner Agreement
Uniform Resource Locator
Women, Infant’s and Children’s Program
WIC is a Special Supplemental Food Program established by Congress in 1972, and federally funded through the United States Department of Agriculture (USDA) to assist states in safeguarding the health and nutritional well-being of our low income women, infants, and children during critical growth periods. The Department of Health and Environmental Control (DHEC) has been designated to administer the program in South Carolina.