Common use of Out-of-Network Provider Reimbursement Clause in Contracts

Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to Hoosier Healthwise members at a rate it negotiates with the out- of-network provider, or the lesser of the following: ▪ The charges billed by the provider; or ▪ 100% of the established Indiana Medicaid FFS reimbursement rates that exist for participating IHCP providers at the time the service was rendered.

Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to Hoosier Healthwise members at a rate it negotiates with the out- ofout-of- network provider, or the lesser of the following: ▪  The charges billed usual and customary charge made to the general public by the provider; or ▪ 100% of the  The established Indiana Medicaid FFS reimbursement rates that exist for participating IHCP providers at the time the service was rendered.

Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to Hoosier Healthwise members at a rate it negotiates with the out- out-of-network provider, or the lesser of the following: ▪ The charges billed by the provider; or ▪ 10098% of the established Indiana Medicaid FFS reimbursement rates that exist for participating IHCP providers at the time the service was rendered.

Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to Hoosier Healthwise members at a rate it negotiates with the out- ofout-of- network provider, or the lesser of the following: ▪ The charges billed usual and customary charge made to the general public by the provider; or ▪ 100% of the The established Indiana Medicaid FFS reimbursement rates that exist for participating IHCP providers at the time the service was rendered.

Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to Hoosier Healthwise members at a rate it negotiates with the out- out-of-network provider, or the lesser of the following: ▪ The charges billed by the provider; or EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE ▪ 10098% of the established Indiana Medicaid FFS reimbursement rates that exist for participating IHCP providers at the time the service was rendered.

Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to Hoosier Healthwise members at a rate it negotiates with the out- out-of-network provider, or the lesser of the following: ▪  The charges billed usual and customary charge made to the general public by the provider; or ▪ 100% of the  The established Indiana Medicaid FFS reimbursement rates that exist for participating IHCP providers at the time the service was rendered.

Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for of- authorized services provided to Hoosier Healthwise members at a rate it negotiates with the out- ofout-of- network provider, or the lesser of the following: ▪ The charges billed usual and customary charge made to the general public by the provider; or ▪ 100% of the The established Indiana Medicaid FFS reimbursement rates that exist for participating IHCP providers at the time the service was rendered.