Terms Used In South Carolina Code > Title 38 > Chapter 70 - Utilization Reviews and Private Review Agents

• 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.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
• Certificate: means a renewable certificate of registration granted by the director or his designee to a private review agent, authorizing the agent to perform utilization review activities in this State for two years. See South Carolina Code 38-70-10
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Department: means the Department of Insurance of South Carolina. See South Carolina Code 38-1-20
• Designee or deputy director: means the person or persons appointed by the director, serving at the will and pleasure of the director as his designee, to supervise and carry out the functions and duties of the department as provided by law. 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
• Director or his designee: means the director or his designee of the South Carolina Department of Insurance. See South Carolina Code 38-70-10
• Fraud: Intentional deception resulting in injury to another.
• insurance: includes annuities. See South Carolina Code 38-1-20
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• 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
• Private review agent: means a person performing utilization reviews who is either under contract with or acting on behalf of, but not employed by:
  
  (a) a South Carolina business entity;
  
  (b) the State of South Carolina; or
  
  (c) a hospital. See South Carolina Code 38-70-10
• Service of process: The service of writs or summonses to the appropriate party.
• Statute: A law passed by a legislature.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Utilization review: means a system for reviewing the necessary, appropriate, and efficient allocation of health care resources and services given or proposed to be given to a patient or group of patients. See South Carolina Code 38-70-10
• Utilization review program: means an overview of the activities performed by the private review agent. See South Carolina Code 38-70-10