Partially Allowed Claim definition

Partially Allowed Claim means any claim line for a Covered Service or Supply provided to a Plan Member that is not a Denied Claim and for which the Allowed Amount is less than the amount billed by the provider. Partially Allowed Claims must relate to services provided to a Plan Member by an Out-of-Network Provider or an Out-of-Network Provider Group.
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Partially Allowed Claim means any claim line for a Covered Service or Supply provided to a Plan Member that is not a Denied Claim and for which the Allowed Amount is less than the amount billed by the provider. Partially Allowed Claims must relate to services provided to a Plan Member by an Out-Of-Network Provider or an Out-Of-Network Provider Group.
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Examples of Partially Allowed Claim in a sentence

  • For each eligible and properly-documented Partially Allowed Claim submitted against the Provider Prove-Up Fund, the Settlement Administrator will make a payment to the Provider Class Member out of the Provider Prove-Up Fund.

  • For Partially Allowed Claims that were reimbursed by the Company from March 1, 2001 to August 19, 2011, the Settlement Administrator will pay an amount equal to the lesser of (i) the Balance ▇▇▇▇ paid by the Subscriber Class Member for that Covered Service or Supply or (ii) 5% of the Allowed Amount for that Partially Allowed Claim.

  • For Partially Allowed Claims that were reimbursed by the Company from June 3, 2003 to August 19, 2011, the Settlement Administrator will pay an amount equal to the lesser of (i) the Balance ▇▇▇▇ outstanding for that Covered Service or Supply or (ii) 5% of the Allowed Amount for that Partially Allowed Claim.

  • For each eligible and properly-documented Partially Allowed Claim submitted against the Subscriber Prove-Up Fund, as described above, the Settlement Administrator will make a payment to the Subscriber Class Member out of the Subscriber Prove-Up Fund.

  • If the Proof of Claim Form is not completed or does not reflect that a Partially Allowed Claim is eligible for reimbursement from the Subscriber Prove-Up Fund, the Subscriber Class Member will not be entitled to payment from the Subscriber Prove-Up Fund.

  • For Partially Allowed Claims that were reimbursed by the Company from August 20, 2011 to the Preliminary Approval Date, the Settlement Administrator will pay an amount equal to the lesser of (i) the Balance ▇▇▇▇ outstanding for that Covered Service or Supply or (ii) 3% of the Allowed Amount for that Partially Allowed Claim.

  • If a Subscriber Class Member fails to provide the Settlement Administrator with the required supporting documentation for a particular Partially Allowed Claim, no payments shall be made from the Subscriber Prove-Up Fund with respect to that Partially Allowed Claim, nor will that Partially Allowed Claim be included in the calculation of the aggregate out-of-pocket payments required under Section 10.1(d).

  • Supporting documentation that demonstrates a Balance ▇▇▇▇ was presented to or sent to the Plan Member prior to the Preliminary Approval Date relating to the Partially Allowed Claim.

  • If the Proof of Claim Form is not completed or does not reflect that a Partially Allowed Claim is eligible for reimbursement from the Provider Prove-Up Fund, the Provider Class Member will not be entitled to any payments from the Provider Prove-Up Fund.

  • In addition to completing the Proof of Claim Form, to be eligible to receive payment from the Subscriber Prove-Up Fund, each Subscriber Class Member must also provide supporting documentation for each Partially Allowed Claim listed on the Proof of Claim Form.

Related to Partially Allowed Claim

  • Allowed Claim means an Allowed Claim of the type described.

  • Disallowed Claim means (a) a Claim, or any portion thereof, that has been disallowed by a Final Order or a settlement, (b) a Claim or any portion thereof that is Scheduled at zero or as contingent, disputed, or unliquidated and as to which a proof of claim bar date has been established but no proof of claim has been timely filed or deemed timely filed with the Bankruptcy Court pursuant to either the Bankruptcy Code or any Final Order of the Bankruptcy Court or otherwise deemed timely filed under applicable law, or (c) a Claim or any portion thereof that is not Scheduled and as to which a proof of claim bar date has been established but no proof of claim has been timely filed or deemed timely filed with the Bankruptcy Court pursuant to either the Bankruptcy Code or any Final Order of the Bankruptcy Court or otherwise deemed timely filed under applicable law.

  • Allowed Amount means the total amount of reimbursement allocated to a covered Service and includes both the BCBSAZ payment and the Member Cost-share payment. BCBSAZ calculates deductible and Coinsurance based on the Allowed Amount, less any access fees or Precertification Charges. BCBSAZ uses the Allowed Amount to accumulate toward any Out-of-pocket Coinsurance Maximum or Out-of-pocket Maximum that applies to the member’s Benefit Plan. The Allowed Amount does not include any balance bills from noncontracted Providers. The Allowed Amount is neither tied to, nor necessarily reflective of, the amounts Providers in any given area usually charge for their services. The table below shows how BCBSAZ determines the Allowed Amount:

  • Rollover Distribution shall be defined as set forth in Section 5.05, herein."

  • Allowed Secured Claim means all or that portion of a Secured Claim which is an Allowed Claim.