Allowable Fee definition

Allowable Fee means the maximum charge payable to a Provider for a specific procedure in accordance with the provisions in Article VI of this Contract. The Provider shall charge the usual and customary fee unless the fee schedule limits otherwise.

Allowable Fee means the maximum charge payable to an Oral Surgeon for a specific procedure in accordance with the provisions in Article VI of this Contract. The Oral Surgeon shall charge the usual and customary fee unless the fee schedule limits otherwise.

Allowable Fee means the maximum amount payable to a Facility by EGID and Member for Covered Services furnished pursuant to this Contract.

Examples of Allowable Fee in a sentence

• Payment for any maternity services by the professional provider is limited to the Allowable Fee for total maternity care, which includes delivery, prenatal and postpartum care.

• Blue Cross and Blue Shield of Montana will utilize the same claim processing rules and/or edits that it utilizes in processing Participating Provider claims for processing claims submitted by nonparticipating providers which may also alter the Allowable Fee for a particular service.

• The charge for a surgical suite outside of the Hospital is included in the Allowable Fee for the surgery.Surgical Services Billed by an Outpatient Surgical Facility or Freestanding Surgery CentersServices of a surgical facility or a freestanding surgery center licensed, or certified for Medicare, by the state in which it is located and have an effective peer review program to assure quality and appropriate patient care.

• For services for which a Medicare reimbursement rate is not available, the Allowable Fee for nonparticipating providers will represent an average contract rate for Participating Providers adjusted by a predetermined factor established by the Plan and updated on a periodic basis.

• Payment to a nonparticipating provider or a non-PPO provider for Covered Medical Expenses is based on the Allowable Fee.

More Definitions of Allowable Fee

Allowable Fee means the maximum amount payable to an ASC in accordance with the provisions in Section VI of this Contract.

Allowable Fee means the maximum charge payable to a Physician Assistant for a specific procedure in accordance with the provisions in Article VI of this Contract. The Physician Assistant shall charge the usual and customary fee unless the fee schedule limits otherwise.

Allowable Fee means the maximum fee payable to a Facility for a specific procedure in accordance with the provisions in Article VI of this Contract.

Allowable Fee means the maximum charge payable to a Durable Medical Equipment Vendor for a specific product in accordance with the provisions in Article VI of this Contract. The Durable Medical Equipment Vendor shall charge the usual and customary fee unless the fee schedule limits otherwise.

Allowable Fee means the maximum charge payable to a Home Health Care Agency for a specific procedure in accordance with the provisions in Article VI of this Contract. The Home Health Care Agency shall charge the usual and customary fee unless the fee schedule limits otherwise.

Allowable Fee means the maximum charge payable to a Clinical Nurse Specialist for a specific procedure in accordance with the provisions in Article VI of this Contract. The Clinical Nurse Specialist shall charge the usual and customary fee unless the fee schedule limits otherwise.

Allowable Fee means the maximum charge payable to an Infusion Therapy Provider for a specific procedure in accordance with the provisions in Article VI of this Contract. The Infusion Therapy Provider shall charge the usual and customary fee unless the fee schedule limits otherwise.