Recognized Amount means, for purposes of this Amendment only, an amount determined pursuant a state law that provides a method for determining the total amount payable for the item or service (if applicable); or, if there is no state law that provides a method for determining the total amount payable for the item or service, the lesser of the Qualifying Payment Amount or billed charges.
Recognized Amount means: (1) an amount determined by reference to an applicable All-Payer Model Agreement under section 1115A of the Social Security Act; (2) if there is no applicable All-Payer Model Agreement, an amount determined by reference to a specified state law; or (3) if there is no applicable All-Payer Model Agreement or specified state law, the lesser of the amount billed by the provider or facility or the QPA.
Recognized Amount means, with respect to an
Examples of Recognized Amount in a sentence
Any Cost Sharing requirement for the items and Services will be calculated based on the Recognized Amount.
More Definitions of Recognized Amount
Recognized Amount means, except for Non-Network air ambulance services, an amount determined under an applicable all-payer model agreement, or if unavailable, an amount determined by applicable state law. If no such amounts are available or applicable and for Non-Network air ambulance services generally, the Recognized Amount shall mean the lesser of a Provider’s billed charge or the Qualifying Payment Amount.
Recognized Amount means the lesser of the amount
Recognized Amount means the amount which the Copayment, Coinsurance and any applicable CYD, is based on for the below Covered Services when provided by Non-Plan Providers. The amount is based on either: • Applicable state law, or • The qualifying payment amount as determined under applicable law for the following Covered Services: o Non-Plan Emergency Covered Services.
Recognized Amount means (in order of priority) one of the following:
Recognized Amount means the lesser of the amount initially billed by the provider or the qualifying payment amount.
Recognized Amount means, for purposes of this section only, an amount determined pursuant a state law that provides a method for determining the total amount payable for the item or service (if applicable); or, if there is no state law that provides a method for determining the total amount payable for the item or service, the lesser of the Qualifying Payment Amount or billed charges. “visit” includes, for purposes of this section only, covered items and services provided as part of nonemergency services furnished by a Non-Participating Provider, regardless of whether the Non-Participating Provider is present at a Participating Facility when furnishing the covered items or services.
Recognized Amount means, with respect to air