Commercial Payer definition

Commercial Payer means a third party Payer of Covered Services other than the Medicare program, which has entered into a Program Agreement with KYOne HP, including, any employer, union group, association, managed care plan, insurer, HMO, PPO, federal, state, or government Payer, including any applicable Medicaid program or any third party administrator contracting on behalf of any such entity.

Commercial Payer means a third-party payer of covered services, other than Medicare and Medicaid, including any state government, employer, Health Maintenance Organization (“HMO”), Medicare Advantage, or any third-party administrator contracting on behalf of any such entity.

Commercial Payer means health insurance plans holding a certificate of authority from Vermont’s Commissioner of Financial Regulation. This term does not include coverage for accident or disability income insurance, liability insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, automobile medical payment insurance, credit-only insurance, coverage for on-site medical clinics, or other similar insurance coverage if benefits for health services are secondary or incidental to other insurance benefits. This term includes Medicare Advantage plans, but does not include stand-alone dental or vision benefits; long-term care insurance; specific disease or other limited benefit coverage, Medicare supplemental health benefits, and other similar benefits.

Examples of Commercial Payer in a sentence

• The State must ensure that at least one Commercial Payer operating in the State offers a Commercial Payer Hospital Global Budget to Participant Hospitals by the start of PY2.

• The State must establish a Commercial Payer Hospital Global Budget methodology no later than PY2 that aligns with the Hospital Global Budget Alignment Requirements for State-Designed Medicare FFS Hospital Global Budget Methodologies articulated in Appendix D for use in PY2, and maintain a Commercial Payer Hospital Global Budget methodology for each subsequent PY.

• No later than the end of PY1, the State must submit to CMS its plan to use available State legislative or regulatory authority to ensure Commercial Payer adoption of the Commercial Payer Hospital Global Budget methodology by PY3.

• During the Implementation Period of the Model, to the extent allowable by law, the State must establish data use agreements with each Commercial Payer operating in the State to acquire data needed to calculate the Statewide All-Payer TCOC Growth Target, All-Payer Primary Care Investment Targets, and set appropriate hospital global budgets for the Participant Hospitals.

• If the State fails ensure at least one Commercial Payer operating in the State offers a Commercial Payer Hospital Global Budget to Participant Hospitals by the start of PY2.

• CMS will offer technical assistance to the State to facilitate Commercial Payer alignment with primary care transformation under AHEAD.

• The State must provide a copy of any agreement, Memorandum of Understanding (MOU), or other legal instrument entered into between the State and a Commercial Payer that effectuates the Commercial Payer Hospital Global Budgets to CMS no later than 90 days before the start of PY2.

• The State must use available State legislative or regulatory authority to ensure Commercial Payer adoption of the Commercial Payer Hospital Global Budget methodology by PY3.

More Definitions of Commercial Payer

Commercial Payer means a third party Payer of Covered Services other than the Medicare program, which has entered into a CIN Agreement with AHN, including, any employer, union group, association, managed care plan, insurer, HMO, PPO, federal, state, or government Payer, including any applicable Medicaid program or any third party administrator contracting on behalf of any such entity.

Commercial Payer means any private health insurance company.