Commercial Health Insurance definition

Commercial Health Insurance. Is health insurance provided and administered by non- governmental entities. It covers medical expenses. Covered Services: Involuntary Treatment Services that meet requirements of RCW 71.05, 71.24.300, and 71.34, including such conditions as Medically Necessary and proper authorization, and in accordance with the Supplemental Provider Service Guide, Policies and Procedures, Protocols, and then applicable laws and regulations. Facility-based Provider: A health care professional, who is employed by or under contract or supervision to render behavioral health services to individuals involuntarily committed to said facility. Facility-based Providers include, but are not limited to, Licensed Mental Health Professionals, Certified Substance Use Disorder Professional, Psychiatrists, Certified Peer Support Counselor, and registered nurses. Facility Participating Provider: A health care professional, facility, CBHC Supervising Provider, or other organization that has a written Facility Participating Provider Agreement in effect with North Sound BH-ASO, directly or through another entity, to provide Involuntary Inpatient Behavioral Health Services.
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Commercial Health Insurance means group and individual commercial health insurance, including the accompanying administrative services, and the administrative services provided to self-insured entities. Commercial health insurance excludes government programs such as Medicare and Medicaid, and alternative products offered by health insurers such as Medicare Advantage that are not available to individuals who do not qualify for Medicare or Medicaid.
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Examples of Commercial Health Insurance in a sentence

  • Topic #668 Claims Processed by Commercial Health Insurance That Is Secondary to MedicareIf a crossover claim is also processed by commercial health insurance that is secondary to Medicare (e.g., Medicare supplemental), the claim will not be forwarded to ForwardHealth.

  • Seek Payment From the Child's Commercial Health Insurance Instead of assuming the cost of the child's commercial health insurance liability, providers may seek payment from the child's commercial health insurance before seeking payment from Wisconsin Medicaid.

  • Submission Topic #16937 Electronic Claims and Claim Adjustments With Other Commercial Health Insurance InformationEffective for claims and claim adjustments submitted electronically via the Portal or PES software on and after June 16, 2014, other insurance information must be submitted at the detail level on professional, institutional, and dental claims and adjustments if it was processed at the detail level by the primary insurance.

  • Topic #16937 Electronic Claims and Claim Adjustments With Other Commercial Health Insurance InformationEffective for claims and claim adjustments submitted electronically via the Portal or PES software on and after June 16, 2014, other insurance information must be submitted at the detail level on professional, institutional, and dental claims and adjustments if it was processed at the detail level by the primary insurance.

  • Topic #16937 Electronic Claims and Claim Adjustments with Other Commercial Health Insurance InformationEffective for claims and claim adjustments submitted electronically via the Portal or PES software on and after June 16, 2014, other insurance information must be submitted at the detail level on professional, institutional, and dental claims and adjustments if it was processed at the detail level by the primary insurance.

  • Topic #603 Services Not Requiring Commercial Health Insurance BillingProviders are not required to bill commercial health insurance sources before submitting claims for the following: ● Case management services.● CCS (Comprehensive Community Services).● Crisis Intervention services.● CRS (Community Recovery Services).● CSP (Community Support Program) services.● Family planning services.● PNCC (prenatal care coordination) services.● Preventive pediatric services.● SMV (specialized medical vehicle) services.

  • When the Commercial Health Insurance Liability Requirement Does Not ApplyThe insurance liability requirement does not apply for the following SBS: ● DME.● Development, revision, review, and annual evaluation/re-evaluation of the IEP.● Nursing services.● Other developmental testing and assessments.● Psychological services, counseling, and social work services.● SLP, audiology, and hearing services.● Transportation services.

  • Submission Topic #16937 Electronic Claims and Claim Adjustments with Other Commercial Health Insurance InformationEffective for claims and claim adjustments submitted electronically via the Portal or PES software on and after June 16, 2014, other insurance information must be submitted at the detail level on professional, institutional, and dental claims and adjustments if it was processed at the detail level by the primary insurance.

  • New West and the Hospital Defendants must divest New West’s fully‐insured Commercial Health Insurance Business to the Acquirer through a bulk‐reinsurance agreement, as provided by Mont.

  • New West and the Hospital Defendants must divest the remainder of New West’s Commercial Health Insurance Business, including its administrative‐services‐only contracts, to the Acquirer at the same time as they divest New West’s fully‐insured business.

Related to Commercial Health Insurance

  • Health insurance means protection which provides payment of benefits for covered sickness or injury.

  • Health insurance carrier or "carrier" means any entity subject to the insurance

  • Health insurance plan means any health insurance policy or health benefit plan offered by a health insurer or a subcontractor of a health insurer, as well as Medicaid and any other public health care assistance program offered or administered by the State or by any subdivision or instrumentality of the State. The term includes vision care plans but does not include policies or plans providing coverage for a specified disease or other limited benefit coverage.

  • Health insurer means the same as that term is defined in Section 31A-22-615.5.

  • Individual health insurance coverage means health insurance coverage offered to individuals in the

  • Health insurance policy means a policy that provides specified benefits for hospital and/or general treatment and meets all requirements under section 63-10 of the Private Health Insurance Act 2007.

  • Health insurance issuer means an insurance company, or insurance organization (including a health

  • Group health insurance coverage means in connection with a group health plan, health insurance

  • Health insurance exchange means an exchange as defined in 45 C.F.R. Sec. 155.20.

  • Accident and health insurance means contracts that incorporate morbidity risk and provide protection against economic loss resulting from accident, sickness, or medical conditions and as may be specified in the valuation manual.

  • Health insurance coverage means benefits consisting of medical care (provided directly, through

  • Credit accident and health insurance means insurance on a debtor to provide

  • Basic health plan means the plan described under chapter

  • Health Insurance Portability and Accountability Act means the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936, as amended.

  • health institution means an organisation whose primary purpose is the care or treatment of patients or the promotion of public health;

  • Rural health clinic means a rural health clinic as defined under section 1861 of part C of title XVIII of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395x, and certified to participate in medicaid and medicare.

  • Health plan or "health benefit plan" means any policy,

  • Home health aide means an individual employed by a home health agency to provide home health services under the direction of a registered nurse or therapist.

  • National Flood Insurance Program means the program created by the U.S. Congress pursuant to the National Flood Insurance Act of 1968 and the Flood Disaster Protection Act of 1973, as revised by the National Flood Insurance Reform Act of 1994, that mandates the purchase of flood insurance to cover real property improvements located in Special Flood Hazard Areas in participating communities and provides protection to property owners through a Federal insurance program.

  • health worker means a person who has completed a course of

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Medical malpractice insurance means insurance against legal liability incident to the practice and provision of a medical service other than the practice and provision of a dental service.

  • Health planning region means a contiguous geographical area of the Commonwealth with a

  • Disabled parking license plate means a license plate that displays the international symbol of access

  • Licensed mental health professional or "LMHP" means a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, licensed behavior analyst, or licensed psychiatric/mental health nurse practitioner.

  • Home health aide services means the personal care and maintenance activities provided to individuals for the purpose of promoting normal standards of health and hygiene.