Glossary


South Carolina Medicaid terminology: SC Web Tool, Screening Requirements, Credit Balance Reporting, Third-Party Liability, Adjustments



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A

abuse

The improper or excessive use of program benefits, resources or services by providers or beneficiaries.

adjudication

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

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.

Attorney General

(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."