Glossary

A State agency that is in charge of the State’s Medicaid program and can give information about programs to help pay medical bills for people with low incomes. Also provides help with prescription drug coverage.

A State agency that has the authority to terminate, sanction, or prosecute fraudulent providers under State law.

A constitution, statue, regulation, rule, common law, or any other State action having the force and effect of law.

A state agency that regulates insurance and can provide information about Medigap policies and any insurance-related problem.

A State program that gets money from the Federal Government to give free local health insurance counseling to people with Medicare.

Free or low-cost health insurance is available now in your state for uninsured children under age 19. State Children’s Health Insurance Programs help reach uninsured children whose families earn too much to qualify for Medicaid, but not enough to get private coverage. Information on your state’s program is available through Insure Kids Now at 1-877-KIDS NOW (1-877-543-7669). You can also look at www.insurekidsnow.gov on the web for more information.

Inspections of Medicare provider facilities to ensure compliance with Federal health, safety, and program standards.

Under HIPAA, this is a transaction that complies with the applicable HIPAA standard.

Certain computer systems currently used by carriers and FIs to process Medicare claims. For physician and lab claims, the system is Electronic Data Systems (EDS); for facility and other Part A provider claims, the system is the Fiscal Intermediary Standard System (FISS), formerly known as the Florida Shared System (FSS); and for supplier claims, the system is the Viable Information Processing System (VIPS).

Dialysis performed by the staff of the renal dialysis center or facility.