Inter-Plan Programs definition
Examples of Inter-Plan Programs in a sentence
The Inter-Plan Programs available to Members under this Agreement are described generally below.
Recovery amounts determined in this way will be applied in accordance with applicable Inter-Plan Programs policies, which generally require correction on a claim-by-claim or prospective basis.
Blue Cross and Blue Shield has a variety of relationships with other Blue Cross and/or Blue Shield Licensees referred to generally as “Inter-Plan Programs.” Whenever Members access health care services outside of Massachusetts, the claim for those services may be processed through one of these Inter-Plan Programs and presented to Blue Cross and Blue Shield for payment.
Blue Cross and Blue Shield has a variety of relationships with other Blue Cross and/or Blue Shield Licensees referred to generally as “Inter-Plan Programs.” Whenever Members access health care services outside of Massachusetts, the claim for those services may be processed through one of these Inter-Plan Programs and presented to Blue Cross and Blue Shield for payment in compliance with the Inter-Plan Programs policies then in effect.
However, in accordance with applicable Inter-Plan Programs policies then in effect, the Host Blue will be responsible for providing such services as contracting and handling substantially all interactions with its participating healthcare providers.
Host Blues using either an estimated price or an average price may, in accordance with Inter-Plan Programs policies, prospectively increase or reduce such prices to correct for over- or underestimation of past prices (i.e., prospective adjustments may mean that a current price reflects additional amounts or credits for claims already paid to providers or anticipated to be paid to or received from providers).
In certain situations, Keystone may use other payment bases, such as billed covered charges, the payment Keystone would make if the healthcare services had been obtained within our service area, or a special negotiated payment, as permitted under Inter-Plan Programs Policies, to determine the amount Keystone will pay for services rendered by non-participating healthcare providers.
However, in accordance with applicable Inter-Plan Programs policies then in effect, the Host Blue will be responsible for providing such services as contracting and handling substantially all interactions with its participating healthcare providers including some managed care services, as applicable.
Blue Shield has a variety of relationships with other Blue Cross and/or Blue Shield Plans and their Licensed Controlled Affiliates (“Licensees”) referred to generally as “Inter-Plan Programs.” Whenever you obtain healthcare services outside of California, the claims for these services may be processed through one of these Inter-Plan Programs.
Any other services will not be covered when processed through any Inter-Plan Programs arrangements unless authorized by a Member’s primary care physician (“PCP”).