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Glossary

Centers for Medicare & Medicaid Services (CMS): The United States Department of Health and Humans Services (USDHHS) agency is responsible for providing oversight and coordination in working with states to administer the Medicaid program.

IV&V: Independent Verification and Validation (IV&V) is verification and validation performed by a third-party organization that is technically, managerially and financially independent of the development organization.

IVR: Interactive Voice Response (IVR) is an automated telephony system that interacts with callers, gathers information and routes calls to the appropriate recipients.

Managed Care Organization: A managed care organization (MCO) is a health plan with a group of doctors and other providers working together to give health services to its members. Healthy Connections Medicaid has five health plans, Absolute Total Care, First Choice by Select Health of South Carolina, Healthy Blue, Molina Healthcare of SC and WellCare. Learn about the health plans

Medicaid: A joint federal-state program, administered by the Centers for Medicare & Medicaid Services, that helps states in supporting medical costs for eligible persons with low incomes and limited resources. South Carolina's Medicaid program is called Healthy Connections.

Medically Necessary: Medically necessary services are health care services or supplies needed to identify or treat an illness, injury, condition, disease or its symptoms. The services or supplies must meet acceptable standards of medicine.

MMIS: A Medicaid Management Information System (MMIS) is a mechanized claims processing and information retrieval system that all states are required to have according to section 1903(a)(3) of the Social Security Act. All states operate a MMIS to support Medicaid business functions and maintain information in such areas as provider enrollment, member eligibility, third party liability, benefit package maintenance, managed care enrollment, care management, financial management, claims processing, and prior authorization.

Module: A module a separable component that is interchangeable with others. It refers to the technology that allows the breaking up of a single MMIS system into smaller, more manageable modules, without replacing entire systems. A modular approach to MMIS is a low-risk, incremental implementation of reusable modules that work with existing systems. First introduced in 2006 as part of the Medicaid Information Technology Architecture (MITA) Framework, the Centers for Medicare and Medicaid Services (CMS) now encourages states to implement modularity in their MMIS systems.

RMMIS: Replacement Medicaid Management Information System (RMMIS) is the South Carolina Medicaid Management Information System and related components. RMMIS is the largest IT transformation in South Carolina state government. SCDHHS is one of the first states in the nation to take on a modular replacement of this magnitude.          

SaaS: Software as a service (Saas) is a software licensing and delivery model in which software is licensed on a subscription basis and is centrally hosted. It is sometimes referred to as "on-demand software." 

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