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 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.

Examples of Commercial Payer in a sentence

• Paragraph 82 outlines approaches to compliance with the Price Constraint in the event that “BILH and a Covered Commercial Payer [enter] into an agreement that provides payment for a Commercial Health Insurance Product to BILH or a Covered BILH Provider through one or more Alternative Payment Methods…”.Date Due: Price Constraint Period (March 1, 2019 – February 28, 2026).

• Paragraph 73 specifies that, for any Contract Year of a Payer Contract executed on or after the Filing Date, the Commercial Unit Price Rate of Increase for Covered BILH Providers agreed to in any Payer Contract with any Covered Commercial Payer shall not be greater than the System-wide Price Constraint.

• Paragraph 81 outlines the procedure that should be utilized to complete revenue projections “[if] BILH and a Covered Commercial Payer agree to a change in Unit Price or a Uniform Price change…occurs during a Contract Year”.Date Due: Price Constraint Period (March 1, 2019 – February 28, 2026).

• Commercial Payer Telehealth Tracking: COVID-19 Public Health Emergency is a helpful resource on the status of telehealth coverage.

• MISSION STATEMENT The mission of the Commercial Payer Relations (CPR) Committee is to be an advocate for HBMA membership by establishing meaningful relationships with commercial payers.

• Commercial Payer Contracting Strategy Update Kimberly Miranda, Chief Financial Officer Sandra Wellington, Manager, Payor RelationsEllen Gallagher Parsons, Principal, Chancellor Consulting Group Ms. Wellington and Ms. Parsons reviewed the report beginning on agenda packet page 59.

• For purposes of this policy, the terms below have the following meanings: Adverse Benefit Determination refers to a determination by a Commercial Payer regarding benefits afforded to an Attributed Individual under a commercial health plan, or a determination by DVHA regarding matters defined by 42 CFR § 438.400(b) under the VMNG Program.

• GMCB may verify attribution and Commercial Payer’s calculations of attribution and may require from Commercial Payer only such information necessary and permitted by law to achieve this purpose.

• Payers Included in Enrollment Trends Commercial Payer Public PayerData SourcesMassHealth5MA APCDMedicare Fee-for-Service (Parts A and B)CMSSource: Massachusetts All-Payer Claims Database (MA APCD), Supplemental Payer Data (Supp.), Centers for Medicare and Medicaid Services (CMS), Not Applicable (N/A)Notes: The Massachusetts Health Connector provided additional payer-level enrollment data on coverage purchased through the exchange.

• HBMA’s Commercial Payer Relations Committee compiled a list of the most commonly requested information on a provider application form.

More Definitions of Commercial Payer

Commercial Payer means any private health insurance company.