Glossary


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



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M

Medicaid

The joint Federal/State entitlement program, enacted in 1965 as Title XIX of the Social Security Act, that pays for medical care on behalf of certain groups of low-income persons.

Medicaid Insurance Verification Service

(MIVS) - implemented and designed to give the Medicaid program information that can be used to verify or re-verify private health insurance coverage for Medicaid beneficiaries.

Medically necessary

Related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care .

Moodle

Moodle (abbreviation for Modular Object-Oriented Dynamic Learning Environment) is a free and open-source e-learning software platform, also known as a Course Management System, Learning Management System, or Virtual Learning Environment (VLE).

N

National Provider Identification

(NPI) - A unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).

Notice of Privacy Practices

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of our system except when the release is required or authorized by law or regulation.

O

Optional State Supplementation

The OSS program is designed to provide a monthly payment on behalf of eligible aged, blind or disabled persons who need assistance paying the licensed/enrolled Community Residential Care Facilities where they live.

P

Primary Care Physician

(PCP) A primary care physician is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis.

Protected Health Information

(PHI) - under HIPAA includes any individually identifiable health information.  Identifiable refers not only to data that is explicitly linked to a particular individual, it also includes health information with data items which reasonably could be expected to allow individual identification.

R

Remittance Advice

(RA) A document that describes payments that are being made (like a receipt of the payment). An RA provides details on how claims were paid or why they were denied.

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