Fee-for-Service Contracted Services. PPG shall render Contracted Services to Members of CHAMPUS/TRICARE Programs, including the TRICARE Prime and TRICARE Extra Programs and shall accept as payment in full, the lesser of: a negotiated percentage of CMAC (CHAMPUS Maximum Allowable Charges, not to exceed 100% of such charges), or the rates set forth in this Addendum G for Covered Services and all other services (including payment for any and all sales, use or other applicable taxes on the sale or delivery of medical services) rendered under this Agreement to Members, less Copayment or Cost Share amounts payable by Members in accordance with the Benefit Program. Such compensation shall be paid within 30 working days of receipt by FHFS of a complete and accurate claim for Contracted Services rendered to a Member in accordance with the provisions of this Agreement. In the case where preauthorization is required, but not obtained prior to services being rendered, the claim will be denied.
Appears in 2 contracts
Samples: Provider Services Agreement (Prospect Medical Holdings Inc), Provider Services Agreement (Prospect Medical Holdings Inc)
Fee-for-Service Contracted Services. PPG shall render Contracted Services to Members of CHAMPUS/TRICARE Programs, including the TRICARE Prime and TRICARE Extra Programs and shall accept as payment in full, the lesser of: a negotiated percentage of CMAC ([CHAMPUS Maximum Allowable Charges, not to exceed one hundred percent (100% %) of such charges)], or the rates set forth in this Addendum G for Covered Services and all other services (including payment for any and all sales, use or other applicable taxes on the sale or delivery of medical services) rendered under this Agreement to Members, less Copayment or Cost Share amounts payable by Members in accordance with the Benefit Program. Such compensation shall be paid within 30 working days of receipt by FHFS of a complete and accurate claim for Contracted Services rendered to a Member in accordance with the provisions of this Agreement. In the case where preauthorization is required, but not obtained prior to services being rendered, the claim will be denied.
Appears in 1 contract
Samples: Provider Services Agreement (Prospect Medical Holdings Inc)
Fee-for-Service Contracted Services. PPG shall render Contracted Services to Members of CHAMPUS/TRICARE Programs, including the TRICARE Prime and TRICARE Extra Programs and shall accept as payment in fullfall, the lesser of: a negotiated percentage of CMAC (CHAMPUS Maximum Allowable Charges, not to exceed 100% of such charges), or the rates set forth in this Addendum G for Covered Services and all other services (including payment for any and all sales, use or other applicable taxes on the sale or delivery of medical services) rendered under this Agreement to Members, less Copayment or Cost Share amounts payable by Members in accordance with the Benefit Program. Such compensation shall be paid within 30 working days of receipt by FHFS of a complete and accurate claim for Contracted Services rendered to a Member in accordance with the provisions of this Agreement. In the case where preauthorization is required, but not obtained prior poor to services being rendered, the claim will be denied.
Appears in 1 contract
Samples: Provider Services Agreement (Prospect Medical Holdings Inc)
Fee-for-Service Contracted Services. PPG shall render Contracted Services to Members of CHAMPUS/TRICARE Programs, including the TRICARE TRICARE, Prime and TRICARE Extra Programs and shall accept as payment in full, the lesser of: a negotiated percentage of CMAC (CHAMPUS Maximum Allowable Charges, not to exceed 100% of such charges), or the rates set forth in this Addendum G for Covered Services and all other services (including payment for any and all sales, use or other applicable taxes on the sale or delivery of medical services) rendered under this Agreement to Members, less Copayment or Cost Share amounts payable by Members in accordance with the Benefit Program. Such compensation shall be paid within 30 working days of receipt by FHFS of a complete and accurate claim for Contracted Services rendered to a Member in accordance with the provisions of this Agreement. In the case where preauthorization is required, but not obtained prior to services being rendered, the claim will be denied.
Appears in 1 contract
Samples: Provider Services Agreement (Prospect Medical Holdings Inc)