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ACA Affordable Care Act

ADA America Dental Association

AFDC Aid to Families with Dependent Children

AG Attorney General

ASO Administrative Services Organization

BCBS Blue Cross/Blue Shield

CARC Claim Adjustment Reason Codes

CCN Claim Control Number

CCR Change Control Record

CLTC Community Long-Term Care

CMS Centers for Medicare & Medicaid Services

COB Coordination of Benefits

CPT Current Procedural Terminology

CSO Care Coordination Services Organization

DDSN Department of Disabilities and Special Needs

DEERS Defense Eligibility and Enrollment Reporting System

DHEC Department of Health and Environmental Control

DHHS Department of Health and Human Services

DME Durable Medical Equipment

DMH Department of Mental Health

DOB Date of Birth

DOS Date of Service

DSS Department of Social Services

DVR Department of Vocational Rehabilitation

ECF Edit Correction Form

EDI Electronic Data Interchange

EFT Electronic Funds Transfer

EMPS Employee Performance Management System

EOB Explanation of Benefits

EOMB Explanation of Medicare Benefits

ER Emergency Room

ERA Electronic Remittance Advice

ESRD End Stage Renal Disease

FAQs Frequently Asked Questions

FFS Fee-for-Service

FOIA Freedom of Information Act

FTP File Transfer Protocol

GAPS Gap Assistance Pharmacy Program for Seniors

HCK Healthy Connections Kids

HIIRF Health Insurance Information Referral Form

HIPAA Health Insurance Portability and Accountability Act

HIPP Health Insurance Premium Payment Program

HMO Health Maintenance Organization

IPC Integrated Personal Care

ISP Internet Service Provider

IVRS Interactive Voice Response System

LIF Low Income Families

LMS Learning Management System

MARS Management and Administration Reporting System

MCCS Medicaid Claims Control System

MCO Managed Care Organization

MEDS Medicaid Eligibility Determination System

MHN Medical Homes Network

MIVS Medicaid Insurance Verification Service

MMIS Medicaid Management Information System

NPI National Provider Identification

OC Other Coverage

OIG Office of Inspector General

OSS Optional State Supplementation

P/RSPCE Preventive and Rehabilitative Services for Primary Care Enhancement

PA Prior Authorization

PACE Program of All Inclusive Care for the Elderly (PACE) program

PCCM Primary Care Case Management

PCP Primary Care Physician

PEP Physician Enhanced Program

PHI Protected Health Information

PMPM Per-Member-Per-Month

POS Point of Sale

PSC Provider Service Center

QI Qualifying Individual

QMB Qualified Medicare Beneficiary

RA Remittance Advice

RARC Remittance Advice Reason Codes

REF Reasonable Effort

SAO State Auditor’s Office

SCDHHS South Carolina Department of Health and Human Services

SCHA South Carolina Hospital Association

SCHCC South Carolina Healthy Connections Choices

SCHIP State Children’s Health Insurance Program

SCMSA South Carolina Medicaid Service Area

SCMWBCST South Carolina Medicaid Web Based Claims Submission Tool

SLMB Special Low Income Medicare Beneficiary

SSA Social Security Administration

SSI Supplemental Security Income

SURS Surveillance and Utilization Review System

TAD Turn Around Document

Keyword(s): TADs

TEFRA Tax Equity and Fiscal Responsibility Act

TPA Trading Partner Agreement

TPL Third Party Liability

URL Uniform Resource Locator

VA Veteran’s Administration

VR Void/Replacement

WIC Women, Infant’s and Children’s Program

WMCC Medically Complex Children’s Waiver Program

WT Web Tool

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