Allowed Charge definition
Allowed Charge. An amount that is not more than the usual or customary charge for the service or supply as determined by Us, based on a standard which is most often charged for a given service by a Provider within the same geographic area .
Allowed Charge means an amount that is not more than the negotiated fee schedule. AMBULANCE. A certified transportation vehicle for transporting Ill or Injured people that contains all life-saving equipment and staff as required by applicable state and local law. AMBULATORY SURGICAL CENTER. A Facility mainly engaged in performing Outpatient Surgery. It must:
Allowed Charge means an amount that is not more than the negotiated fee schedule. AMBULANCE. A certified transportation vehicle for transporting Ill or Injured people that contains all life-saving equipment and staff as required by applicable state and local law. AMBULATORY SURGICAL CENTER. A Facility mainly engaged in performing Outpatient Surgery. It must: be staffed by Practitioners and Nurses, under the supervision of a Practitioner; have operating and recovery rooms; be staffed and equipped to give emergency care; and have written back-up arrangements with a local Hospital for emergency care. It must carry out its stated purpose under all relevant state and local laws and be either: accredited for its stated purpose by either The Joint Commission or the Accreditation Association for ambulatory care; or approved for its stated purpose by Medicare. A Facility is not an Ambulatory Surgical Center, for the purpose of this Contract, if it is part of a Hospital. ANNUAL OPEN ENROLLMENT PERIOD. The designated period of time each year during which: individuals are permitted to enroll in a standard health benefits plan or standard health benefits plan with rider; and individuals who already have coverage may replace current coverage with a different standard health benefits plans or standard health benefits plan with rider. [APPROVED CANCER CLINICAL TRIAL. A scientific study of a new therapy or intervention for the treatment, palliation, or prevention of cancer in human beings that meets the following requirements: The treatment or intervention is provided pursuant to an approved cancer clinical trial that has been authorized or approved by one of the following: 1) The National Institutes of Health (Phase I, II and III); (2) the United States Food and Drug Administration, in the form of an investigational new drug (IND) exemption (Phase I, II and III); 3) The United States Department of Defense; or 4) The United States Department of Veteran Affairs. The proposed therapy has been reviewed and approved by the applicable qualified Institutional Review Board. The available clinical or pre-clinical data to indicate that the treatment or intervention provided pursuant to the Approved Cancer Clinical Trial will be at least as effective as standard therapy, if such therapy exists, and is expected to constitute an improvement in effectiveness for treatment, prevention and palliation of cancer. The Facility and personnel providing the treatment are capable of doing so by virtue of thei...
Examples of Allowed Charge in a sentence
In the event that transportation is Medically Necessary and Appropriate, We will cover the amount We Determine to be the Allowed Charge cost.
Benefits may be based on the Allowed Charge (AC), or some similar term.
For charges that are not determined by a negotiated fee schedule, the [Member] may be billed for the difference between the Allowed Charge and the charge billed by the Provider.
An amount that is not more than the [lesser of: • the] allowance for the service or supply as determined by Us based on a standard approved by the Board[; or [• the negotiated fee schedule.] The Board will decide a standard for what is considered an Allowed Charge under this Contract.
In this section, a Plan that bases benefits on an Allowed Charge is called an “AC Plan.” Benefits may be based on a contractual fee schedule, sometimes called a negotiated fee schedule, or some similar term.
Please note: The Coordination of Benefits and Services provision includes a distinct definition of Allowed Charge.] AMBULANCE.
Please note: The Coordination of Benefits and Services provision includes a distinct definition of Allowed Charge.
The amount of any charge, which is greater than the Allowed Charge.
More Definitions of Allowed Charge
Allowed Charge means an amount that is not more than the negotiated fee schedule. AMBULANCE. A certified transportation vehicle for transporting Ill or Injured people that contains all life-saving equipment and staff as required by applicable state and local law. AMBULATORY SURGICAL CENTER. A Facility mainly engaged in performing Outpatient Surgery. It must: be staffed by Practitioners and Nurses, under the supervision of a Practitioner; have operating and recovery rooms; be staffed and equipped to give emergency care; and have written back-up arrangements with a local Hospital for emergency care. It must carry out its stated purpose under all relevant state and local laws and be either: accredited for its stated purpose by either The Joint Commission or the Accreditation Association for ambulatory care; or approved for its stated purpose by Medicare. A Facility is not an Ambulatory Surgical Center, for the purpose of this Contract, if it is part of a Hospital. ANNUAL OPEN ENROLLMENT PERIOD. The designated period of time each year during which: individuals are permitted to enroll in a standard health benefits plan ; and individuals who already have coverage may replace current coverage with a different standard health benefits plans. [APPROVED CANCER CLINICAL TRIAL. A scientific study of a new therapy or intervention for the treatment, palliation, or prevention of cancer in human beings that meets the following requirements: The treatment or intervention is provided pursuant to an approved cancer clinical trial that has been authorized or approved by one of the following: 1) The National Institutes of Health (Phase I, II and III); (2) the United States Food and Drug Administration, in the form of an investigational new drug (IND) exemption (Phase I, II and III); 3) The United States Department of Defense; or 4) The United States Department of Veteran Affairs. The proposed therapy has been reviewed and approved by the applicable qualified Institutional Review Board. The available clinical or pre-clinical data to indicate that the treatment or intervention provided pursuant to the Approved Cancer Clinical Trial will be at least as effective as standard therapy, if such therapy exists, and is expected to constitute an improvement in effectiveness for treatment, prevention and palliation of cancer. The Facility and personnel providing the treatment are capable of doing so by virtue of their experience and training The trial consists of a scientific plan of treatment that inc...
Allowed Charge means an amount that is not more than the lesser of the allowance for the service or supply as determined by the standard approved by the Board as set forth at N.J.A.C. 11:21-7.13 or the negotiated fee schedule.
Allowed Charge means an amount that is not more than the negotiated fee schedule.