Provider/Supplier Reimbursement and Member Liability Sample Clauses

Provider/Supplier Reimbursement and Member Liability. The Provider’s Reasonable Charge is the allowance or payment that the Plan has determined is reasonable for covered services provided to a member based upon the provider who renders such services. Specifically, it is the portion of the provider’s billed charge that will be recognized by the Plan and used to calculate the benefit payable and the financial liability of the member under the Agreement. In the event that a provider has not agreed to accept the Provider’s Reasonable Charge as payment in full, any amounts billed by the provider in excess of the Provider’s Reasonable Charge are not covered under the Agreement and shall be the financial responsibility of the member. Deductible and coinsurance amounts shall be applied to the Provider’s Reasonable Charge to determine the benefit amount payable by the Plan. See Section II. COMPREHENSIVE MAJOR MEDICAL EXPENSE COVERAGE, Subsection J. Benefit Amounts, Durations, Limits, Deductibles and Coinsurance for Benefits Under the Agreement of this Outline for the definition of “Provider’s Reasonable Charge”.
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Provider/Supplier Reimbursement and Member Liability. The Provider’s Reasonable Charge is the allowance or payment that the Plan has determined is reasonable for covered services provided to a member based upon the provider who renders such services. Specifically, it is the portion of the provider’s billed charge that will be recognized by the Plan and used to calculate the benefit payable and the financial liability of the member under this Agreement. In the event that a provider has not agreed to accept the provider’s Reasonable Charge as payment in full, any amounts billed by the provider in excess of the Provider’s Reasonable Charge are not covered under this Agreement and shall be the financial responsibility of the member. Deductible and coinsurance amounts shall be applied to the Provider’s Reasonable Charge to determine the benefit amount payable by the Plan.
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Related to Provider/Supplier Reimbursement and Member Liability

  • Provider Services The Contractor’s system shall collect, process, and maintain current and historical data on program providers. This information shall be accessible to all parts of the MCMIS for editing and reporting.

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  • GENERAL OBLIGATIONS OF THE SUPPLIER/SERVICE PROVIDER 9.1 The Supplier/Service Provider shall:

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