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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E

EFT Agreement

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
organizations by electronic means.

Electronic Remittance Advice

(ERA) - Allows providers to receive information concerning payment in an electronic format. ERA provides details on how claims were paid or why they were denied.

Explanation of Benefits

(EOB) - An Explanation of Benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatment and/or services were paid for on their behalf.

F

Fee-For-Service

(FFS) A system for the payment of professional services in which the practitioner is paid for the particular service rendered; separate payment to a health-care provider for each medical service rendered to a patient; a payment mechanism.

File Transfer Protocol

(FTP) This is the method used to send in your claims electronically.

fraud

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

(FOIA) - A law that requires the U.S. Government to give out certain information to the public when it receives a written request. FOIA applies only to records of the Executive Branch of the federal government, not to those of the Congress or federal courts, and does not apply to state governments, local governments or private groups.

G

Gap Assistance Pharmacy Program for Seniors

(GAPS) will provide state pharmacy assistance to “fill the gap” for seniors’ Medicare prescription drug coverage when their drug costs reach the “doughnut hole”. The GAPS program will pay 10% of your drug costs while you are experiencing the coverage gap.

Grant-in-Aid

A giving of federal funds to a state or local government to subsidize a public project; help provide for programs of assistance or service to the public.

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