Qualifying Payment Amount means, for purposes of this Amendment 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 the Member’s cost-share requirements, including Deductibles, Copayments, and/or Coinsurance, will be the lesser of the Qualifying Payment Amount or billed charges.
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 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.
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
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