Allowed Cost definition

Allowed Cost means the Medicaid costs reported by each Connecticut in-state hospital in their most recent inpatient cost report as filed as of July 31st of each year by the hospitals for the hospital fiscal year.]
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Allowed Cost means a cost described in Schedule 1 and Schedule 2;
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Examples of Allowed Cost in a sentence

  • Maximum Allowed Cost and/or Maximum Allowable Charge shall mean the maximum amount payable for a Covered Service under the Contract and meeting Medical Necessity and Prior Authorization requirements.

  • Likewise, when multiple procedures are performed on the same day by the same physician or other healthcare professional, we may reduce the Maximum Allowed Cost (MAC)s for those secondary and subsequent procedures because reimbursement at 100% for those procedures would represent duplicative payment for components of the primary procedure that may be considered incidental or inclusive.

  • For Covered Services performed by an In- Network Provider, the Maximum Allowed Cost (MAC) for this plan is the rate the Provider has agreed with Alliant to accept as reimbursement for the Covered Services.

  • In order to assist you in understanding the Maximum Allowed Cost (MAC) language as described below, please refer to the definition of In-Network Provider, Out-of-Network Provider and Non- Preferred Provider contained in the Definitions section of this booklet.

  • The amount of payment for the professional service provided via telemedicine by the Physician or practitioner at the distant site is based on the current Maximum Allowed Cost (MAC) for the service provided.

  • Because In-Network Providers have agreed to accept the Maximum Allowed Cost (MAC) as payment in full for that service, they should not send you a bill or collect for amounts above the Maximum Allowed Cost (MAC).

  • The Maximum Allowed Cost (MAC) may vary depending upon whether the Provider is an In-Network or an Out-of-network Provider.

  • For prescription drugs and diabetic supplies rendered by a pharmacy, the Maximum Allowed Cost (MAC) is the amount determined by us using prescription drug cost information provided by the pharmacy benefits manager.

  • If we authorize a Covered Service so that you are responsible for the In-Network cost share amounts, you may still be liable for the difference between the Maximum Allowed Cost (MAC) and the Out-of-Network Provider’s charge.

  • However, you may receive a bill or be asked to pay all or a portion of the Maximum Allowed Cost (MAC) to the extent you have not met your Deductible or have a Copayment or Coinsurance.