For network providers. For a Provider who has a written agreement with Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide care to a Covered Person at the time Covered Services for medical benefits are rendered (“Network Provider”), the contracting Allowable Amount is based on the terms of the Network Provider’s contract and the payment methodology in effect on the date of the Covered Service. The payment methodology used may include diagnosis-related groups (DRG), fee schedule, package pricing, global pricing, per diems, case-rates, discounts, or other payment methodologies.
Appears in 4 contracts
Samples: Administrative Services Agreement, Administrative Services Agreement, Administrative Services Agreement
