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

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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

(HIPAA) is the federal law that establishes standards for the privacy and security of health information, as well as standards for electronic data interchange (EDI) of health information.

Health Maintenance Organization

(HMO) - Health maintenance organization. When you sign up for an HMO, you choose one doctor to coordinate all your health care. This doctor, your "primary care physician," learns your entire medical history. He or she recommends care based on knowing you from head to toe. This saves you money, as opposed to going to different specialists for different aches and pains, which costs more. If you should ever need care from a specialist, your primary care physician will refer you to one in your health plan's network. HMOs help their members receive quality care at reasonable prices.

Healthy Connections Kids

Health Connections Kids is a health insurance program for uninsured children. SC Healthy Connections Kids (SCHIP)

Home Health

A facility that offers skilled nursing care and other services to patients in their homes. These include occupational, physical and speech therapies, medical social services and home health aide services.


A public agency or private organization that is primarily engaged in providing pain relief, symptom management, and supportive services to patients that are certified to be terminally ill. Medicare beneficiaries may elect to receive hospice care instead of standard Medicare benefits for terminal illnesses. Under Medicaid, beneficiaries electing hospice no longer receive Medicaid covered therapeutic service.


Learning Management System

(LMS) - A learning management system is a software application for the administration, documentation, tracking, and reporting of training programs, classroom and online events, e-learning programs, and training content.

Low Income Families

The (LIF) group includes at least one child in the home must be under age 18 or age 19 if in a secondary school. Four-month extended Medicaid individuals who lost their original LIF benefit due to increased child support. Their Medicaid benefits continue for four months after they become ineligible for LIF. Transitional Medicaid (TM) allows individuals up to 24 months of Medicaid benefits after the loss of LIF eligibility if earnings or hours of employment of the parent or caretaker relative, or loss of earned income, caused LIF ineligibility.


Management and Administration Reporting System

(MARS) - A significant component of the Administrative Services Program.  This MMIS (Medicaid Management Information System) subsystem creates financial reports for fiscal planning, management, control, and state/federal reporting reporting requirements.

Mechanized Claims Processing

Mechanized claims processing and information retrieval system or system means the system of software and hardware used to process Medicaid claims from providers of medical care and services for the medical care and services furnished to recipients under the medical assistance program and to retrieve and produce service utilization and management information required by the Medicaid single state agency and federal government for program administration and audit purposes.  The system consists of (1) required subsystems specified in the State Medicaid Manual (2) required changes to the required system or subsystem that are published in accordance with 433.123 of this subpart and specified in the State Medicaid Manual; and (3) approved enhancements to the system.  Eligibility determination systems are not part of mechanized claims processing and information retrieval systems or enhancements to those systems.

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