Appeals Information Management System
MES Module DMAS created to process claim appeals
Monthly payment for an insurance plan
Request for payment of services rendered
Centers for Medicare & Medicaid Services
Care Management Solution developed by DMAS
Department of Medical Assistance Services
Enterprise Data Warehouse Solution
Determination if member meets all criteria required to receive benefits
Record of data for insurance payers that provides details about claims paid to providers for services
Process where providers/members request to participate in Medicare and/or other health insurance programs
Encounter Processing Solution
These claims are broken down into individual services.
State Pays Provider Directly
INT
Integrated Services Solution
Local Department of Social Services
Level of Care
Level of Care Review Instrument
Long Term Services and Support
MCO
Person who performs tasks on behalf of an MCO or PAH
Federal and state program that helps with medical costs for qualified individuals with limited income and resources
Person who currently has or previously had health insurance
Medicaid Enterprise System
Framework established by CMS that includes national guidelines for technologies, information, & business processes common to all State Medicaid Enterprises
This system is used to store & transfer info & carryout the tasks for their Medicaid processes
Stand-alone system that can be integrated with other modules in an MES to carry out the tasks for their Medicaid processes
Nursing Facility
National Provider Identifier
Program of All-Inclusive Care for the Elderly
Primary Account Holder
Pharmacy Benefit Management Solution
Person, group, or entity that provides healthcare services
Provider Services Solution
System Integration Testing
Agencies that work with CMS to administer Medicaid, CHIP, and health insurance portability standards
Bodily injury caused to a person due to negligence or recklessness of a 3rd party
User accepted testing
Virginia Medicaid Management Information System
Virginia Department of Health