Maximum Allowable Fee definition

Maximum Allowable Fee means the fees for Covered Services established by PICO and/or Payor, as amended from time to time.

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Maximum Allowable Fee means a dollar amount Wellmark establishes using various methodologies for Covered Services and supplies. For medical services, this amount is developed from various sources, such as charges billed for the same service or supply by most health care providers within Iowa, economic indicators, or relative value indices developed or approved by Wellmark, and is based on the simplicity or complexity of the service provided. For medical services received outside of Iowa or South Dakota, the Maximum Allowable Fee is either determined in accordance with the section of this Agreement entitled Out-of-Area Services or is the amount as described in the preceding sentence. For all dental procedures covered under this Agreement, the fee schedule is developed based on Wellmark’s contracts with dentists, input from its dental consultants, and the charges billed for the same procedure by dentists in Iowa.

Maximum Allowable Fee means the attorney or foreclosure fee amount agreed to with a client or the applicable investor/insurer/agency that is intended to provide compensation to the Law Firm for all services that are typically required to be performed by foreclosure counsel to prosecute and complete an uncontested foreclosure or eviction in Colorado.

Examples of Maximum Allowable Fee in a sentence

• For Covered Services rendered to Enrollees within the PPO Network, Provider will be paid the lower of Provider’s usual fee or InterWest’s Maximum Allowable Fee.

• The County is not required to make retroactive payment adjustments consistent with the Wisconsin BadgerCare Plus Maximum Allowable Fee Schedule and hospital reimbursement made by the State of Wisconsin for fee-for-service providers, including but not limited to, payments for inpatient and outpatient hospital services.

• The term "Benefit Payment" means a payment issued by the Contract Administrator to a provider or Participant based on the Maximum Allowable Fee Schedule for an in-network service or supply.

• The Maximum Allowable Fee Schedule is a payment system that reimburses up to a specified dollar amount for services rendered.

• The County is not required to make retroactive payment adjustments consistent with the Wisconsin BadgerCare Plus Maximum Allowable Fee Schedule and Hospital reimbursement made by the State of Wisconsin for fee- for-service providers including, but not limited to, payments for inpatient and outpatient hospital services.

• These include, but are not limited to, the portion of charge in excess of Corporation's Maximum Allowable Fee as determined by Corporation; adjustments required by Corporation’s billing policy and procedure; adjustments required through Utilization Management/Quality Improvement policy and procedure; other contractual provisions.

• If any term of this Agreement becomes invalid or unenforceable by reason of any existing or future federal or state law, directive, order, rule, regulation, or decision by a court of last resort, such invalidity or unenforceability will not affect or impair any other terms or provisions of this Agreement.

• The County is not required to make retroactive payment adjustments consistent with the Wisconsin Medicaid Maximum Allowable Fee Schedule and Hospital reimbursement made by the State of Wisconsin for fee-for-service providers including, but not limited to, payments for inpatient and outpatient hospital services.

• If the applicable Benefits Document provides benefits for Covered Services rendered by health care providers that have not contracted with Wellmark or another Blue Cross and Blue Shield Plan (“Non-Contracting Providers”), Members may be liable to Non-Contracting Providers for any difference between the Covered Charges and the Maximum Allowable Fee and Members are responsible for paying the provider in full, except to the extent prohibited by applicable law, including the federal No Surprises Act.

• If the applicable Benefits Document provides benefits for Covered Services rendered by health care providers that have not contracted with Wellmark or another Blue Cross and Blue Shield Plan (“Non-Contracting Providers”), Members may be liable to Non-Contracting Providers for any difference between the Covered Charges and the Maximum Allowable Fee and Members are responsible for paying the provider in full.

More Definitions of Maximum Allowable Fee

Maximum Allowable Fee. (( - )) means the maximum dollar amount that the agency will pay a provider for specific services, supplies and equipment.

Maximum Allowable Fee means a dollar amount Wellmark establishes using various methodologies for Covered Services and supplies. For medical services, this amount is developed from various sources, such as charges billed for the same service or supply by most health care providers within Iowa, economic indicators, or relative value indices developed or approved by Wellmark, and is based on the simplicity or complexity of the service provided. For medical services received outside of Iowa or South Dakota, the Maximum Allowable Fee is either determined in accordance with the section of this Agreement entitled Out-of-Area Services or is the amount as described in the preceding sentence.

Maximum Allowable Fee means a dollar amount Wellmark establishes using various methodologies for Covered Services and supplies. For medical services, this amount is

Maximum Allowable Fee means the maximum dollar amount that the department will reimburse a provider for spe- cific services, supplies, and equipment.

Maximum Allowable Fee means an amount Wellmark establishes using various methodologies for Covered Services and supplies.

Maximum Allowable Fee means a dollar amount Wellmark establishes using various methodologies for Covered Services and supplies. For medical services, this amount is developed from various sources, such as charges billed for the same service or supply by most health care providers within Iowa, economic indicators, or relative value indices