Compensation for Medicare Advantage Sample Clauses

Compensation for Medicare Advantage. Health Plan agrees to compensate Provider on a fee-for-service basis for Covered Services provided under the Medicare Advantage Product that are determined by Health Plan to be payable pursuant to Laws, Government Program Requirements, and this Agreement and that are submitted on a Clean Claim, less any applicable amounts paid or to be paid by other liable third-parties and the Member for cost-sharing, including, but not limited to, co-payments, deductibles, or co-insurances, if any, at the lesser of the following amounts in effect for the Date of Service: (i) Provider’s billed charges; or (ii) an amount equivalent to the Medicare Fee-for-Service Program allowable payment rate, geographically adjusted (“Medicare Rate”). Notwithstanding any other term of the Agreement, compensation will be thirty percent (30%) of Provider’s billed charges, not to exceed seventy-five dollars ($75.00), for those Covered Services where there is no Medicare Rate. Except when otherwise set forth by a Law or Government Program Requirement, Provider agrees that Health Plan will implement updates or revisions to the Medicare Fee-for-Service Program fee schedules on a prospective basis within sixty (60) days of the update or revision from the agency. The update or revision will be applied to all Claims received after the implementation and Health Plan will not be required to retrospectively adjust any Claims.