Maximum Allowable Fee definition

Maximum Allowable Fee means a dollar amount Wellmark establishes using various methodologies for Covered Services and supplies. For medical services, this amount is developed from various sources, such as charges billed for the same service or supply by most health care providers within Iowa, economic indicators, or relative value indices developed or approved by Wellmark, and is based on the simplicity or complexity of the service provided. For medical services received outside of Iowa or South Dakota, the Maximum Allowable Fee is either determined in accordance with the section of this Agreement entitled Out-of-Area Services or is the amount as described in the preceding sentence. For all dental procedures covered under this Agreement, the fee schedule is developed based on Wellmark’s contracts with dentists, input from its dental consultants, and the charges billed for the same procedure by dentists in Iowa.
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Maximum Allowable Fee means the fees for Covered Services established by PICO and/or Payor, as amended from time to time.
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Maximum Allowable Fee means the attorney or foreclosure fee amount agreed to with a client or the applicable investor/insurer/agency that is intended to provide compensation to the Law Firm for all services that are typically required to be performed by foreclosure counsel to prosecute and complete an uncontested foreclosure or eviction in Colorado.
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Examples of Maximum Allowable Fee in a sentence

  • For Covered Services rendered to Enrollees within the PPO Network, Provider will be paid the lower of Provider’s usual fee or InterWest’s Maximum Allowable Fee.

  • Covered Expense is either the customary and reasonable charge or the Maximum Allowable Fee Schedule for professional services, depending on your plan.

  • If the applicable Benefits Document provides benefits for Covered Services rendered by health care providers that have not contracted with Wellmark or another Blue Cross and Blue Shield Plan (“Non-Contracting Providers”), Members may be liable to Non-Contracting Providers for any difference between the Covered Charges and the Maximum Allowable Fee and Members are responsible for paying the provider in full.

  • The Maximum Allowable Fee Schedule is a payment system that reimburses up to a specified dollar amount for services rendered.

  • The County is not required to make retroactive payment adjustments consistent with the Wisconsin BadgerCare Plus Maximum Allowable Fee Schedule and hospital reimbursement made by the State of Wisconsin for fee-for-service providers, including but not limited to, payments for inpatient and outpatient hospital services.

  • The term "Benefit Payment" means a payment issued by the Contract Administrator to a provider or Participant based on the Maximum Allowable Fee Schedule for an in-network service or supply.

  • The County is not required to make retroactive payment adjustments consistent with the Wisconsin BadgerCare Plus Maximum Allowable Fee Schedule and Hospital reimbursement made by the State of Wisconsin for fee- for-service providers including, but not limited to, payments for inpatient and outpatient hospital services.

  • The fee allowed by the Payor is the lesser of (a) the amount submitted by the Dentist, (b) the Payor’s maximum allowable fee as set forth on the Payor’s Maximum Allowable Fee Schedule, as updated from time to time, for such service, or (c) the maximum allowable in accordance with coordination of benefit insurance laws and regulations.

  • PICO, in its sole discretion, may modify the Maximum Allowable Fee Schedule(s) based upon data available to PICO, including but not limited to data resulting from confidential fee surveys, evaluations, and historical analysis.

  • The amount charged for these services, excluding emergency services, received from an Out-of-Network Provider may exceed the Maximum Allowable Fee in which case you will be responsible for paying the difference between the amount charged and the Maximum Allowable Fee.


More Definitions of Maximum Allowable Fee

Maximum Allowable Fee means the maximum dollar amount that the agency will pay a provider for specific services, supplies and equipment.
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Maximum Allowable Fee means)) - The maximum dollar amount that the ((department)) agency will reimburse a provider for specific services, supplies, and equipment.
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Maximum Allowable Fee means the maximum dollar amount that the department will reimburse a provider for spe- cific services, supplies, and equipment.
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Related to Maximum Allowable Fee

  • Maximum allowable cost means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a drug.

  • Maximum allowable cost list means a list of drugs for

  • Maximum Applied Water Allowance (MAWA) means the upper limit of annual applied water for the established landscaped area as specified in Section 492.4. It is based upon the area's reference evapotranspiration, the ET Adjustment Factor, and the size of the landscape area. The Estimated Total Water Use shall not exceed the Maximum Applied Water Allowance. Special Landscape Areas, including recreation areas, areas permanently and solely dedicated to edible plants such as orchards and vegetable gardens, and areas irrigated with recycled water are subject to the MAWA with an ETAF not to exceed 1.0. MAWA = (ETo) (0.62) [(ETAF x LA) + ((1-ETAF) x SLA)]

  • Applicable Fee means, for any day, with respect to any Commitment, the applicable percentage set forth in Annex I under the caption “Applicable Fee”.

  • Maximum Face Amount means, with respect to any outstanding Letter of Credit, the face amount of such Letter of Credit including all automatic increases provided for in such Letter of Credit, whether or not any such automatic increase has become effective.

  • Maximum Advance Amount shall be Two Hundred Fifty Thousand Dollars ($250,000) per Advance Notice.

  • Maximum allowable residential density means the density allowed under the zoning ordinance and land use element of the general plan, or if a range of density is permitted, means the maximum allowable density for the specific zoning range and land use element of the general plan applicable to the project. Where the density allowed under the zoning ordinance is inconsistent with the density allowed under the land use element of the general plan, the general plan density shall prevail.

  • Maximum Undrawn Amount means with respect to any outstanding Letter of Credit, the amount of such Letter of Credit that is or may become available to be drawn, including all automatic increases provided for in such Letter of Credit, whether or not any such automatic increase has become effective.

  • Utilization Fee shall have the meaning assigned to such term in Section 2.06(b).

  • Minimum Disbursement Amount means Twenty-Five Thousand and No/100 Dollars ($25,000).

  • NOx Allowance means an authorization to emit a specified amount of NOx that is allocated or issued under an emissions trading or marketable permit program of any kind that has been established under the Clean Air Act or a state implementation plan.

  • Allowable Costs means the costs defined as allowable in 42 CFR, Chapter IV, Part 413, as amended to October 1, 2007, except for the purposes of calculating direct medical education costs, where only the reported costs of the interns and residents are allowed. Further, costs are allowable only to the extent that they relate to patient care; are reasonable, ordinary, and necessary; and are not in excess of what a prudent and cost-conscious buyer would pay for the given service or item.

  • Maximum Advance Rate means 80.0%.

  • Maximum Revolving Advance Amount means $25,000,000.

  • Maximum Daily Limit means the maximum allowable "Daily Concentration" (defined above) when expressed as a concentration (e.g. mg/l), otherwise, it means the maximum allowable "Daily Quantity" as defined above, unless it is expressed as a flow quantity. If expressed as a flow quantity it means "Maximum Daily Flow" as defined in Section 22a-430-3(a) of the RCSA.

  • Allowable cost means a cost that complies with all legal requirements that apply to a particular federal education program, including statutes, regulations, guidance, applications, and approved grant awards.

  • Maximum Loan Amount has the meaning set forth in Section 2.1(a).

  • Drawing Fee means, with respect to each Draft drawn by TCCI and purchased by any Person on any Drawing Date and subject to the provisions of Section 2.15, an amount equal to the product of (i) the Applicable Rate times the aggregate Face Amount of the Draft, multiplied by (ii) a fraction the numerator of which is the number of days in the term to maturity of such Draft and the denominator of which is 365 or 366, as applicable.

  • Allowable Amount is defined in the EOC. In addition: • Coinsurance is calculated from the Allowable Amount or Benefit maximum, whichever is less.

  • Maximum Special Tax means the maximum Special Tax, determined in accordance with Section C below, that can be levied in any Fiscal Year on any Assessor’s Parcel.

  • Maximum Revolver Amount means $100,000,000, decreased by the amount of reductions in the Revolver Commitments made in accordance with Section 2.4(c) of the Agreement.

  • Maximum Premium has the meaning set forth in Section 7.06(b).

  • Maximum Applicable Rate with respect to APS, has the meaning set forth in Section 11.10(a)(vii) of these Bylaws.

  • Maximum Lawful Rate has the meaning set forth in Section 2.7.

  • Applicable Commitment Fee Rate shall mean the percentage rate per annum based on the Leverage Ratio then in effect according to the pricing grid on Schedule 1.1(A) below the heading “Commitment Fee.”

  • Adjusted Maximum Amount means, with respect to a Contributing Guarantor as of any date of determination, the maximum aggregate amount of the obligations of such Contributing Guarantor under this Guaranty or a Related Guaranty, in each case determined in accordance with the provisions hereof and thereof; provided that, solely for purposes of calculating the “Adjusted Maximum Amount” with respect to any Contributing Guarantor for purposes of this paragraph 2, the assets or liabilities arising by virtue of any rights to or obligations of contribution hereunder or under any similar provision contained in a Related Guaranty shall not be considered as assets or liabilities of such Contributing Guarantor. “Aggregate Payments” means, with respect to a Contributing Guarantor as of any date of determination, the aggregate amount of all payments and distributions made on or before such date by such Contributing Guarantor in respect of this Guaranty and the Related Guaranties (including, without limitation, in respect of this paragraph 2 or any similar provision contained in a Related Guaranty). The amounts payable as contributions hereunder and under similar provisions in the Related Guaranties shall be determined as of the date on which the related payment or distribution is made by the applicable Funding Guarantor. The allocation among Contributing Guarantors of their obligations as set forth in this paragraph 2 or any similar provision contained in a Related Guaranty shall not be construed in any way to limit the liability of any Contributing Guarantor hereunder or under a Related Guaranty. Each Contributing Guarantor under a Related Guaranty is a third party beneficiary to the contribution agreement set forth in this paragraph 2.