Understanding Insurance: Medicaid

Front 1

ADJUSTED CLAIM

Back 1

Payment correction resulting in additional payments to the provider

Front 2

DUAL ELIGIBLES

Back 2

Individuals who are entitled to Medicare and eligible for some type of Medicaid benefit

Front 3

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services

Back 3

Legislation that requires states to provide routine pediatric checkups to all children enrolled in Medicaid

Front 4

Federal Medical Assistance Percentage (FMAP)

Back 4

Portion of the Medicaid program paid for by the federal government

Front 5

federal poverty level (FPL)

Back 5

Income guidelines established annually by the federal government

Front 6

Mass Health

Back 6

Massachusetts' Medicaid program

Front 7

Medicaid

Back 7

Cost-sharing program between the federal and state governments that provides health care services to low-income Americans

Front 8

Medicaid eligibility verification system (MEVS)

Back 8

System that allows providers to electronically access each state's eligibility file through a point-of-sale device, computer software, or an automated voice response. Sometimes called recipient eligibility verification system (REVS)

Front 9

Medicaid remittance advice

Back 9

Document sent to the provider to explain Medicaid benefits and communicate the statuses of all claims, including adjusted and voided claims

Front 10

MedicaL

Back 10

California's Medicaid program

Front 11

medical assistance program

Back 11

Program for individuals with incomes below the federal poverty level

Front 12

mother/baby claim

Back 12

Claim submitted for services provided to a baby under the mother's Medicaid identification number

Front 13

recipient eligibility verification system (REVS)

Back 13

System that allows providers to electronically access each state's eligibility file through a point-of-sale device, computer software, or an automated voice response. Also called Medicaid eligibility verification system (MEVS).

Front 14

surveillance and utilization review system (SURS)

Back 14

Safeguards that protect against unnecessary or inappropriate use of Medicaid services or excess payments and assess the quality of those services

Front 15

Temporary Assistance for Needy Families (TANF)

Back 15

Program that makes cash assistance available on a time-limited basis for children deprived of support because of a parent's death, incapacity, absence, or unemployment

Front 16

Tenn Care

Back 16

Tennessee's Medicaid program

Front 17

voided claim

Back 17

A claim Medicaid should not have paid. Results in a deduction from the lump sum payment made to the provider