MEDICAID JACKSON
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| adjusted claim | claim where the amount paid has been corrected
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| balance billing | when provider attempts to bill patient the write off
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| community spouse | spouse that lives at home while other is in nursing home suffering
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| dual eligible | receives benefits from medicare and medicaid
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| mother baby claim | used for babys first ten days of life while babys medicaid application is being processed
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| payer of last resort | medicaid is paid last, after every other insurace company, bacuse medicaid had like mo money, at all
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| presumptive eligibilty | allows individuals to be enrolled in medicaid for limited time before full application is filed and processed
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| QMB | resources at below twice SSI standard and +100% of federal proverty level
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| QWDI | recipients do not pay medicare part a permiums
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| remittance advice | details medicaid's reimbursement on claim. law set by state. attached to medicaid claim after otehr insurance is billed
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| SCHIP | covers children up to 19
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| SLMB | recipients do not pay medicare part b peremiums
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| TANF | provides cash assistance for children whose parents are unable to care for them
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| utilization survey | sent to medicaid patients to verity services received in month prior
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| voided claim | claim that medicaid should not have paid
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| EPSDT | early periodic screening diagnostic treatment
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| FMAP | federal medical assistance percentage
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| QI | qualified individual
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| QMB | qulified medicare beneficiary
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| SCHIP | state children health insurance program
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| SLMB | specified low income medicare beneficiary
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| SSI | supplemental security income
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| TANF | temporary assistance for need families
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| medicaid may have to pay | copay, co-insurance, deductible, or permium
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| establishes the max payable amount for each medicare service | state
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| medicaid covers | medical services
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| optometrist | optional service
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| family planning services and supplies | mandatory service
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| verify eligibility of patient's medicaid | every visit
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| any questions about medicaid should be addressed to the | local county government
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| a baby born to medicaid eligible mother receives coverage for | one year
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| medicaid is not free for just anyone who is | medically needy. (must be blow federal proverty level)
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| medicaid if different from | state to state (different state administer things differently)
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| 8 federal requirements for medicaid | TANF
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| 8 federal requirements for medicaid | pregnant + below federal poverty level
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| 8 federal requirements for medicaid | caretakers/children below fpl
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| 8 federal requirements for medicaid | SSI recipient
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| 8 federal requirements for medicaid | medically needy + below fpl
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| 8 federal requirements for medicaid | special groups
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| 8 federal requirements for medicaid | foster family
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| 8 federal requirements for medicaid | instiutionalized individuals
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| medicare coverage categories | mandatory
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| medicare coverage categories | optional
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| medicare coverage categories | preauthorized
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| ways to verify medicaid eligibility | telephone
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| ways to verify medicaid eligibility | internet
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| ways to verify medicaid eligibility | point of service (card swiper)
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| subrogation | assuming an obligation when another party is liable
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