Qualifying Payment Amount definition

Qualifying Payment Amount means, for purposes of this section only, a median of contracted rates calculated pursuant to federal or state law, regulation and/or guidance.

Qualifying Payment Amount means the median of the contracted rates recognized by the Plan, or recognized by all plans serviced by the Plan’s Third Party Administrator (if calculated by the Third Party Administrator), for the same or a similar item or service provided by a Provider in the same or similar specialty in the same geographic region. If there are insufficient (meaning fewer than three) contracted rates available to determine a Qualifying Payment Amount, said amount will be determined by referencing a state all-payer claims database or, if unavailable, any eligible third-party database in accordance with applicable law.

Qualifying Payment Amount means, for purposes of this Amendment only, a median of contracted

Examples of Qualifying Payment Amount in a sentence

• For Air Ambulance Services received from a Non-Participating Provider, if the services would be covered if received from a Participating Provider, the amount used to calculate Your cost-share requirements, including Deductibles, Copayments, and Coinsurance, will be the lesser of the Qualifying Payment Amount or billed charges.

• Qualifying Payment Amount The calculation for this amount is to be determined in accordance with the applicable federal regulation.

• If there are insufficient (meaning at least three) contracted rates to determine a Qualifying Payment Amount, said amount will be determined by referencing a state all-payer claims database or, if unavailable, any third-party database in accordance with applicable law.

• For Air Ambulance Services received from a Non-Participating Provider, if the services would be covered if received from a Participating Provider, the amount used to calculate the Member’s cost-share requirements, including Deductibles, Copayments, and/or Coinsurance, will be the lesser of the Qualifying Payment Amount or billed charges.

• If you receive emergency services from a noncontracted facility or professional provider, BCBSAZ will base the allowed amount used to calculate your cost share on the Qualifying Payment Amount, as defined by federal law.

More Definitions of Qualifying Payment Amount

Qualifying Payment Amount. (QPA) shall mean generally the median contracted rates of the Plan or issuer for the item or service in the geographic region. This amount is subject to change.

Qualifying Payment Amount means, with respect to a sponsor of a group health plan or health insurance issuer offering group health insurance coverage, the amount calculated using the methodology described in paragraph(c) of this section.

Qualifying Payment Amount means, generally, the median contracted rates of the plan or issuer for the item or service in the geographic region, calculated in accordance with 29 CFR § 716-6(c).

Qualifying Payment Amount means, with respect to a sponsor of a group health plan, the amount calculated using the methodologydescribed in paragraph (c) of this section.

Qualifying Payment Amount generally means the median of contracted rates for a specific item or service in the same geographic region within the same insurance market, increased by an inflation index. For more on the methodology for calculation the qualifying payment amount see here.17

Qualifying Payment Amount means the Plan’s median contracted rate for the item or service in the same geographic region, as adjusted under 29 C.F.R. § 2590.716-6(c).

Qualifying Payment Amount means the amount calculated using the methodology described in 45 C.F.R. § 149.140(c), which is based on the median contracted rate for all plans offered by the carrier in the same insurance market for the same or similar item or service that is: provided by a provider in the same or similar specialty or facility of the same or similar facility type; and provided in the geographic region in which the item or service is furnished. The median contracted rate is subject to additional adjustments specified in federal regulations.