Common use of Liability Calculation Method Per Claim Clause in Contracts

Liability Calculation Method Per Claim. The calculation of a Member's liability on claims for covered health care services incurred outside the geographic area BCBSM serves and processed through BlueCard will be based on the lower of the provider's billed charges or the negotiated price BCBSM pays the Host Plan. The methods employed by a Host Plan to determine a negotiated price will vary among Host Plans based on the terms of each Host Plan's provider contracts. The negotiated price paid to a Host Plan by BCBSM on a claim for health care services processed through BlueCard may represent:

Liability Calculation Method Per Claim. The calculation of a Member's liability on claims for covered health care services incurred outside the geographic area BCBSM BCN serves and processed through BlueCard will be based on the lower of the provider's billed charges or the negotiated price BCBSM BCN pays the Host Plan. The methods employed by a Host Plan to determine a negotiated price will vary among Host Plans based on the terms of each Host Plan's provider contracts. The negotiated price paid to a Host Plan by BCBSM BCN on a claim for covered health care services processed through BlueCard may represent: