Terms Used In South Carolina Code > Title 38 > Chapter 59 > Article 2 - South Carolina Health Care Financial Recovery and Protection Act

• APA: means the American Pyrotechnics Association. See South Carolina Code 40-56-20
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Board: means the State Board of Pyrotechnic Safety. See South Carolina Code 40-56-20
• Clean claim: means an eligible electronic or paper claim for reimbursement that:
  
  (a) is received by the insurer within one hundred twenty business days of the date the health care services at issue were performed;
  
  (b)(i) when submitted via paper has all the elements of the standardized CMS 1500 or UB 04 claim form, or the successor of each as either may be amended from time to time; or
  
  (ii) when submitted via an electronic transaction, uses only permitted standard code sets and has all the elements of the standard electronic formats as required by the Health Insurance Portability and Accountability Act of 1996 and other federal and state regulatory authority;
  
  (c) is for health care services covered by the health insurance plan and rendered to an insured person by a provider eligible for reimbursement under the health insurance plan;
  
  (d) has any corresponding referral that may be required for the applicable claim;
  
  (e) is a claim for which the insurer is the primary payor, or for which the insurer's responsibility as a secondary payor has been clearly established;
  
  (f) has no material defect, error, or impropriety that would affect the adjudication of the claim;
  
  (g) includes all required substantiating documentation or coding;
  
  (h) is not subject to any particular circumstance that the insurer reasonably believes, subject to review by the Department of Insurance, would prevent accurate or timely payment from being made on the claim under the terms of the health insurance plan, the participating provider agreement, or the insurer's published filing requirements; and
  
  (i) is under a health insurance plan for which the insurer has been timely paid all applicable premiums. See South Carolina Code 38-59-210
• Consumer fireworks: means any small firework device designed to produce visible effects by combustion and which must comply with the construction, chemical composition, and labeling regulations of the U. See South Carolina Code 40-56-20
• Contract: A legal written agreement that becomes binding when signed.
• Conviction: A judgement of guilt against a criminal defendant.
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Dealer: means any person, corporation, or partnership who buys precious metal or precious or semiprecious stones or gems from the general public, whether in bulk or in manufactured form, with an intent to obtain a monetary profit for himself or for a principal. See South Carolina Code 40-54-10
• Department: means the Department of Labor, Licensing and Regulation. See South Carolina Code 40-56-20
• Department: means the Department of Insurance of South Carolina. See South Carolina Code 38-1-20
• Director: means the person who is appointed by the Governor upon the advice and consent of the Senate and who is responsible for the operation and management of the department. See South Carolina Code 38-1-20
• Display fireworks: means large fireworks designed primarily to produce visible or audible effects by combustion, deflagration, or detonation. See South Carolina Code 40-56-20
• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• Fireworks: means any composition or device designed to produce a visible or an audible effect by combustion, deflagration, or detonation, and which meets the definition of "consumer fireworks" or "display fireworks" as defined by this section. See South Carolina Code 40-56-20
• Force majeure: means any act of God, governmental act, act of terrorism, war, fire, flood, earthquake, hurricane, or other natural disaster, explosion or civil commotion. See South Carolina Code 38-59-210
• Fraud: Intentional deception resulting in injury to another.
• Health care services: means services included in furnishing an individual medical care or hospitalization, or services incident to the furnishing of medical care or hospitalization, and other services to prevent, alleviate, cure, or heal human illness, injury, or physical disability. See South Carolina Code 38-59-210
• Health insurance plan: means a health insurance policy or health benefit plan offered by a health insurer or a health maintenance organization that provides health insurance coverage, as defined in § 38-71-670(6). See South Carolina Code 38-59-210
• Health maintenance organization: means an organization as defined in § 38-33-20(8). See South Carolina Code 38-59-210
• insurance: includes annuities. See South Carolina Code 38-1-20
• Insurer: means an insurance company, a health maintenance organization, and any other entity providing health insurance coverage, as defined in § 38-71-670(6), which is licensed to engage in the business of insurance in this State and which is subject to state insurance regulation. See South Carolina Code 38-59-210
• Legal tender: coins, dollar bills, or other currency issued by a government as official money. ^{Source: U.S. Mint}
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Participating provider: means a provider who provides covered health care services to an insured or a member pursuant to a contract with an insurer or health insurance plan. See South Carolina Code 38-59-210
• Person: means a corporation, agency, partnership, association, voluntary organization, individual, or another entity, organization, or aggregation of individuals. See South Carolina Code 38-1-20
• Physician: means a doctor of medicine or doctor of osteopathic medicine licensed by the South Carolina Board of Medical Examiners. See South Carolina Code 38-59-210
• Policy: means a contract of insurance. See South Carolina Code 38-1-20
• Precious metal: means any article made in whole or in part of gold, silver, or platinum. See South Carolina Code 40-54-10
• Provider: means a physician, hospital, or other person properly licensed, certified, or permitted, where required, to furnish health care services. See South Carolina Code 38-59-210
• Purchase: means the acquisition, including by means of being pawned to a dealer, of precious metal or precious or semiprecious stones or gems or both precious metal and precious or semiprecious stones or gems for a consideration of cash, goods, or other precious metals or precious or semiprecious stones or gems or both precious metals and precious or semiprecious stones or gems. See South Carolina Code 40-54-10
• Pyrotechnics: means any composition or device designed to produce visible or audible effects for entertainment purposes by combustion, deflagration, or detonation. See South Carolina Code 40-56-20