Recognized Amount definition
Recognized Amount means, for purposes of this section only, an amount determined pursuant a state law that provides a method for determining the total amount payable for the item or service (if applicable); or, if there is no state law that provides a method for determining the total amount payable for the item or service, the lesser of the Qualifying Payment Amount or billed charges.
Recognized Amount means, with respect to an
Recognized Amount means the lesser of the amount
Examples of Recognized Amount in a sentence
For nonemergency services performed by Non-Participating Providers during the Member’s visit at a Participating Facility, and for Emergency Services provided by a Non-Participating Provider or Non-Participating Emergency Facility, the Recognized Amount is used to calculate the Member’s cost-share requirements, including Deductibles, Copayments, and/or Coinsurance.
More Definitions of Recognized Amount
Recognized Amount means, except for Non-Network air ambulance services, an amount determined under an applicable all-payer model agreement, or if unavailable, an amount determined by applicable state law. If no such amounts are available or applicable and for Non-Network air ambulance services generally, the Recognized Amount shall mean the lesser of a Provider’s billed charge or the Qualifying Payment Amount.
Recognized Amount means: (1) an amount determined by reference to an applicable All-Payer Model Agreement under section 1115A of the Social Security Act; (2) if there is no applicable All-Payer Model Agreement, an amount determined by reference to a specified state law; or (3) if there is no applicable All-Payer Model Agreement or specified state law, the lesser of the amount billed by the provider or facility or the QPA.
Recognized Amount means, for purposes of this section only, an amount determined pursuant a state law that provides a method for determining the total amount payable for the item or service (if applicable); or, if there is no state law that provides a method for determining the total amount payable for the item or service, the lesser of the Qualifying Payment Amount or billed charges. “visit” includes, for purposes of this section only, covered items and services provided as part of nonemergency services furnished by a Non-Participating Provider, regardless of whether the Non-Participating Provider is present at a Participating Facility when furnishing the covered items or services.
Recognized Amount means the lesser of the amount initially billed by the provider or the qualifying payment amount.
Recognized Amount means the amount which the Copayment, Coinsurance and any applicable CYD, is based on for the below Covered Services when provided by Non-Plan Providers. The amount is based on either: Applicable state law, or The qualifying payment amount as determined under applicable law for the following Covered Services: o Non-Plan Emergency Covered Services.
Recognized Amount. The lesser of the out-of-Network Provider’s billed charges or our median contracted rate for in- Network Providers for the same or similar item or service furnished in the same or similar specialty in the same geographic region; provided that, except in connection with air ambulance services, if there is a recognized amount specified for this purpose under an applicable All-Payer Model Agreement under Section 1115A of the Social Security Act, or if not, under applicable state law, then such amount, as applicable, will instead serve as the Recognized Amount.
Recognized Amount. The lesser of the Out-of-Network Provider’s billed charges or BlueChoice’s median contracted rate for In-Network Providers for the same or similar item or service furnished in the same or similar specialty in the same geographic region, provided that, except in connection with air ambulance services, if there is a Recognized Amount specified for this purpose under an applicable All-Payer Model Agreement under Section 1115A of the Social Security Act or, if not, under applicable state law, then such amount, as applicable, will instead serve as the Recognized Amount.