South Carolina Medicaid terminology: SC Web Tool, Screening Requirements, Credit Balance Reporting, Third-Party Liability, Adjustments
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The improper or excessive use of program benefits, resources or services by providers or beneficiaries.
Claims adjudication in health insurance refers to the determination of the insurer's payment or financial responsibility, after the member's insurance benefits are applied to a medical claim.
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
(AFDC) - A federal assistance program in effect from 1935 to 1996, which was administered by the United States Department of Health and Human Services. This program provided financial assistance to children whose families had low or no income.
(AG) - The Attorney General is South Carolina's Chief Criminal Prosecutor, Chief Legal Officer and Securities Commissioner. The South Carolina Constitution defines the Attorney General's role as "chief prosecuting officer of the State with authority to supervise the prosecution of all criminal cases in courts of record."
A beneficiary is an enrollee who receives a Medicaid-covered service or (beginning 1998) has a managed care or private health insurance premium paid on his/her behalf (an alternate reference to recipient).
Blue Cross/Blue Shield
(BCBS) - Health Insurance Company
Bureau of Care Management and Medical Support
The Bureau of Care Management and Medical Support Services is responsible for the oversight of Managed Care Organizations, Managed Care Beneficiary Enrollment, Medical Support Services that enhance direct care, School-Based and Private Rehabilitative Services, Dental, and Transportation Services.
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 .