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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S

South Carolina Department of Health and Human Services

(SCDHHS) - The Healthy Connections Medicaid program is administered by the South Carolina Department of Health and Human Services, who is responsible for determining beneficiary eligibility and covered services.

State Children’s Health Insurance Program

(SCHIP) - A program designed to provide health coverage to uninsured children with incomes too high to qualify for Medicaid, but too low to afford private health insurance. SCHIP is funded through a Federal/State partnership and was enacted as part of the Balanced Budget Act of 1997.

Surveillance Utilization Review Subsystem

SURS - is a subsystem of the Medicaid Management Information System, which maintains and stores Medicaid claims data.  SURS detects potential misuse of Medcaid by program recipients and providers through data analysis; provides information to facilitate investigation of fraud, waste, and abuse; and produces comprehensive reports for the utilization review staff designed to assist in analyzing quality of care and developing program policy.  The SURS (Surveillance Utilization Review Subsystem) Division produces comprehensive reports that are used for the detection of Medicaid program fraud and abuse, quality of care, and the development of program policy.