Glossary

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

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C

Centers for Medicare & Medicaid Services

(CMS) - The Federal Agency within DHHS that runs Medicare. In addition, CMS works with the States to run the Medicaid and SCHIP programs. CMS works to make sure that the beneficiaries in these programs are able to get high-quality health care.

CHAMPUS

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

(CCN) is a unique control number assigned by a provider/carrier to a non-institutional claim.  This field links each line item with its respective claim.

CMS-1500 Form

CMS- 1500 forms are the standard insurance form used by non-institutional providers all across the United States to process medical insurance claims. It is part of HIPAA to standardize all medical insurance billing.

contractor

A person or business which provides goods or services to another entity under terms specified in a contract.

Current Procedural Terminology

(CPT) - A systematic listing and coding of procedures and services performed by physicians. Each procedure or service is identified with a five-digit code. The use of CPT codes simplifies the reporting of services. With this coding and recording system, the procedure or service rendered by the physician is accurately identified.

D

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

(DHHS) - Administers many of the social programs of the Federal Government dealing with the health and welfare of the citizens of the U.S.

diagnostic codes

Diagnostic codes are used to group and identify diseases, disorders, symptoms, and medical signs, and are used to measure morbidity and mortality.

dual eligibility

Individuals who meet the requirements and are eligible for both Medicaid and Medicare benefits are considered to be dually eligible or dual eligibility beneficiaries.

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