Private review agent means a person or entity performing utilization reviews, except that the term
Private review agent or "agent" means a person or entity performing utilization review that is either affiliated with, under contract with, or acting on behalf of any insurer or other person providing or administering health benefits to citizens of this Commonwealth. "Private review agent" or "agent" does not include an independent review entity which performs external review of adverse determinations;
Private review agent means: (1) a non-hospital affiliated person or entity performing utilization review that is either affiliated with, under contract with, or acting on behalf of a Maryland business entity or a third party that provides or administers hospital benefits to citizens of Maryland including a health maintenance organization, a health insurer, nonprofit health service plan, health insurance service organization, or preferred provider organization authorized to offer health insurance policies or contracts in Maryland; or (2) any person or entity including a hospital-affiliated person performing utilization review for the purpose of making claims or payment decisions on behalf of the employer’s or labor union’s health insurance plan under an employee assistance program for employees other than the employees employed by the hospital; or employed by a business wholly owned by the hospital.
Examples of Private review agent in a sentence
Whereas the reason provided most frequently by men was having more than one sex partner (29.6%).Furthermore, only 5.9% of men in KAIS, 2012, cited the belief that their partner has other sex partners as a reason for being at moderate-to-great risk which is lower than the finding from the current research that had 11%.
Private review agent shall collect only the information necessary to certify the admission, procedure or treatment, length of stay, frequency and duration of services.
More Definitions of Private review agent
Private review agent means a person or entity who performs
Private review agent or "agent" means a person or entity performing utilization
Private review agent means a person performing utilization reviews who is either under contract with or acting on behalf of, but not employed by:
Private review agent means a person or entity performing utilization reviews, except that the term shall not include the following entities or employees of any such entity so long as they conduct utilization reviews solely for subscribers, policyholders, members or enrollees:
Private review agent means any person or entity which performs utilization review services for third-party payors on a contractual basis for outpatient or inpatient services. However, the term shall not include full-time employees, personnel, or staff of health insurers, health maintenance organizations, or hospi- tals, or wholly owned subsidiaries thereof or affiliates under common ownership, when performing utilization review for their respective hospitals, health mainte- nance organizations, or insureds of the same insurance group. For this purpose, health insurers, health main- tenance organizations, and hospitals, or wholly owned
Private review agent means a (1) nonhospital-affiliated person or entity performing utilization review that is either affiliated with, under contract with, or acting on behalf of a Maryland business entity or a third party that pays for, provides, or administers health care services to citizens of the State or (2) any person or entity performing utilization review for the purpose of making claims or payment decisions for health care services on behalf of the employer’s or labor union’s health insurance plan under an employee assistance program for employees other than the employees employed by the hospital or a business wholly owned by the hospital.