Private review agent definition
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 a person or entity performing utilization review, except that the term
More Definitions of Private review agent
Private review agent means any person or entity
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 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 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 (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.
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