Wisconsin - Medicaid SSI - Glossary

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Medicaid SSI




ADVANCE DIRECTIVE - A decision about your healthcare that you make ahead of time in case you are ever unable to speak for yourself. This will let your family and your doctors know what decisions you would make if you were able to.

ASC/SPU - Ambulatory surgical center/short procedure unit.

AUTHORIZATION - An O.K. or approval for a service.

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BENEFITS - Services, procedures and medications that Medicaid SSI will cover for you.

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CLINICAL CARE MANAGEMENT - One-on-one help by a nurse providing education and coordination of Medicaid SSI for Kids benefits, tailored to your needs.

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DISENROLLMENT - To stop your membership in Medicaid SSI.

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EARNED INCOME - Money received from wages, including from a sheltered workshop or work activity center, self-employment earnings, and some royalties and honoraria.

EMERGENCY - When you reasonably believe that your health is in serious danger.

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FEDERAL POVERTY LEVEL (FPL) - Poverty income thresholds by family size that are annually updated by the Census Bureau for inflation.

FRAUD - An untruthful act – an example is someone other than you using your Medicaid SSI member ID card and pretending to be you.

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ID CARD - Identification card – a card that says you are a Medicaid SSI member. You should have this card with you at all times.

INFORMED CONSENT - You agree to all medical treatments.

INPATIENT - When you are admitted into a hospital for a length of time.

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MEDICAL NECESSITY - Your health care provider decides if a treatment, admission, procedure, medical supply, equipment, service or supply is medically necessary.

MEMBER - A person who is eligible for Medicaid SSI.

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OUTPATIENT - When you have a procedure done that does not require a hospital stay overnight.

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PROVIDER - Any medical professional that Medicaid SSI has contracted with to take care of you.

PROVIDER DIRECTORY - A list of providers who participate with Medicaid SSI to help take care of your healthcare needs.

PRIMARY CARE PHYSICIAN (PCP) - A doctor you choose to be your family physician. They have their own private practices.

PRIOR AUTHORIZATION - The process for any service that needs an O.K. from Medicaid SSI before it can take place.

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REFERRAL - When you and your primary care provider agree you need to see another doctor, your primary care provider will send you to a Medicaid SSI specialist.

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SELF-REFERRED SERVICES - Services for which you do not need to see your primary care provider for a referral.

SPECIAL NEEDS UNIT (SNU) - A voluntary service offered by Medicaid SSI that can give you extra help in understanding and using your benefits if you have a disability or other special need.

SPECIALIST - A doctor that has specific, detailed training in one certain medical field.

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TREATMENT - The care that you may receive from doctors and facilities.

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UNEARNED INCOME - Money received from all other sources, such as: gifts, interest, Social Security, Veteran’s benefits or pensions.

URGENT CARE - When you need care, treatment or medical advice within a 24-hour time period.

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