Cost Avoidance definition

Cost Avoidance. A method of paying Claims in which the Provider is not reimbursed until the Provider has demonstrated that all available health insurance has been exhausted.

Cost Avoidance means the difference between the actual cost incurred during a selected time period versus what the cost would have been had the ECM not been implemented, including without limitation avoided, defrayed, or reallocated costs.

Cost Avoidance. The application of a range of tools to identify and prevent inappropriate or medically unnecessary charges before they are actually paid. This may include service authorization, second surgical opinions, medical necessity review, and other pre-and post- payment / service reviews. “Cost Sharing” Co-payments paid by the member in order to receive medical services.

Examples of Cost Avoidance in a sentence

• In case the Customer does not procure any ratchet reset, rate change or other utility tariff charge reduction, or in the event that such ratchet, rate or tariff changes before the Guarantee Period ends, Cost Avoidance nonetheless will be calculated as if the ratchet, rate or tariff has been reset at the end of the installation of demand- reducing ECMs, or continues, as applicable.

• All Cost Avoidance realized by Customer that result from activities undertaken by Honeywell prior to Final Project Acceptance, including any utility rebates or other incentives earned as a direct result of the installed ECMs or M&V Services provided by Honeywell, will be applied toward the Guaranteed Savings for the First Guarantee Year.

• Customer agrees that Baseline adjustment is stipulated to be an escalation of 2% per year for the unit cost of electric utilities, 2% per year for gas utilities, 2% per year for fuel oil, and 2% per year for water or sewer utilities, used in the determination of Cost Avoidance each year.

• Option A methods will be applied on an ECM specific basis (i.e., isolated to the retrofit) and Energy Cost Avoidance for a Guarantee Year will be quantified and summarized on an ECM basis.

• The following parameters, methodologies, and/or calculations were used in determining the Operational Costs and/or Cost Avoidance due to the Retrofit and M&V Services implementation and are agreed to be reasonable and may be used in the calculation of Savings.

More Definitions of Cost Avoidance

Cost Avoidance. A method of paying Claims in which the Provider is not reimbursed until the Provider has demonstrated that all available health insurance, and other sources of Third Party Liability, have been exhausted. Countersignature: An authorization provided by the Enrollee’s PCP, or another Provider within the Enrollee’s PMG, for a prescription written by another Provider to be dispensed. No Countersignature shall be required if the Provider writing the prescription is within the PPN.

Cost Avoidance means the Government special education cost reduction for one Cohort of children. It is calculated by multiplying reported operating cost reductions by the Measurement Error Discount.

Cost Avoidance means the difference between the actual cost incurred during a selected time period versus what the cost would have been had the cost avoidance strategy not been implemented, calculated using agreed upon energy unit costs stated in Section 6.3.

Cost Avoidance. The Contractor shall cost-avoid all claims or services that are subject to third-party payment and may deny a service to a member if it knows that a third party (i.e. other insurer) will provide the service. However, if a third-party insurer (other than Medicare) requires the member to pay any copayment, coinsurance or deductible, the Contractor is responsible for making these payments, even if the services are provided outside of the Contractor's network. The Contractor's liability for copayments, coinsurance and deductibles is limited to what the Contractor would have paid for the entire service pursuant to a written contract with the provider or the AHCCCS fee-for-service rate, less any amount paid by the third party. (The Contractor must decide whether it is more cost-effective to provide the service within its network or pay coinsurance and deductibles for a service outside its network. For continuity of care, the Contractor may also choose to provide the service within its network.) If the Contractor refers the member for services to a third-party insurer (other than Medicare), and the insurer requires payment in advance of all copayments, coinsurance and deductibles, the Contractor must make such payments in advance. If the Contractor knows that the third party insurer will not pay as the result of either exceeding timely filing limits, or as the result of the underlying insurance coverage, and the service is medically necessary, the CYE `05 Acute Care Renewal Amendment October 22, 2004 PROGRAM REQUIREMENTS CONTRACT/RFP NO. YH04-0001 Contractor shall not deny the service nor require a written denial letter. If the Contractor does not know whether a particular service is covered by the third party, and the service is medically necessary, the Contractor shall contact the third party and determine whether or not such service is covered rather than requiring the member to do so. The requirement to cost-avoid applies to all AHCCCS covered services. For prenatal care and preventive pediatric services, AHCCCS may require the Contractor to provide such service and then coordinate payment with the potentially liable third party ("pay and chase"). In emergencies, the Contractor shall provide the necessary services and then coordinate payment with the third-party payer. The Contractor shall also provide medically necessary transportation so the member can receive third-party benefits. Further, if a service is medically necessary, the Contractor shall ensure th...

Cost Avoidance. The application of a range of tools to identify and prevent inappropriate or medically unnecessary charges before they are actually paid. This may include service authorization, second surgical opinion, medical necessity review, and other pre-and post- payment /service reviews. “Cost Sharing” Co-payments paid by the member in order to receive medical services. “COV Security Standards” Commonwealth of Virginia (COV) Information Technology Resource Management (ITRM) policies, standards, and guidelines that may be updated from time to time. A complete list can be located at

Cost Avoidance means a claims processing edit, which rejects a claim, when there is an identified liable third party.

Cost Avoidance means avoiding payment of claims when 1st- or 3rd-party payment sources are available.