Usual and Customary (U&C) Charge definition

Usual and Customary (U&C) Charge means the amount a regular cash-paying customer pays a Pharmacy for a pharmaceutical good or service and is submitted to PBM. PBM shall require Network Pharmacies to submit their Usual and Customary Charges with all Claim submissions.

Examples of Usual and Customary (U&C) Charge in a sentence

  • Usual and Customary (U&C) Charge: The lowest price the pharmacy would charge to a particular customer if such customer were paying cash for the identical prescription drug services on the date dispensed.

  • The Usual and Customary Charge.The Usual and Customary (U&C) Charge is the lesser of: (a) the charge generally made by a Physician or other supplier of services, medicines, or supplies; or (b) the general level of charge made by Physicians or other suppliers within an area in which the charge is incurred for Injury or Sickness comparable in severity and nature to the Injury of Sickness being treated.

  • Usual and Customary (U&C) Charge: the usual and customary price charged by a Pharmacy for a Prescription Drug Product dispensed to a cash paying customer.

Related to Usual and Customary (U&C) Charge

  • Usual and customary charge means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.

  • Usual and Customary Charges means those comparable charges for similar treatment, services and supplies in the geographic area where treatment is performed.

  • Usual and Customary (U&C) shall mean covered expenses which are identified by the Plan Administrator, taking into consideration the fee(s) which the Provider most frequently charges the majority of patients for the service or supply, the cost to the Provider for providing the services, the prevailing range of fees charged in the same “area” by Providers of similar training and experience for the service or supply, and the Medicare reimbursement rates. The term(s) “same geographic locale” and/or “area” shall be defined as a metropolitan area, county, or such greater area as is necessary to obtain a representative cross-section of Providers, persons or organizations rendering such treatment, services, or supplies for which a specific charge is made. To be Usual and Customary, fee(s) must be in compliance with generally accepted billing practices for unbundling or multiple procedures.

  • Reasonable and Customary Charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness / injury involved.

  • Reasonable and Customary means, in relation to a charge for Medical Service, such level which does not exceed the general range of charges being charged by the relevant service providers in the locality where the charge is incurred for similar treatment, services or supplies to individuals with similar conditions, e.g. of the same sex and similar Age, for a similar Disability, as reasonably determined by the Company in utmost good faith. The Reasonable and Customary charges shall not in any event exceed the actual charges incurred.

  • Transition charge means a nonbypassable rate or charge to be imposed on a customer to pay

  • Service Charge means the amount charged for making a service available on line and is in addition to the actual fee for a service itself. For example, one who renews a license on line will pay the license renewal fee and a service charge.

  • Capacity Charge means a charge for public facilities in existence at the time a charge is imposed or charges for new public facilities to be acquired or constructed in the future that are of proportional benefit to the person or property being charged, including supply or capacity contracts for rights or entitlements, real property interests, and entitlements and other rights of the local agency involving capital expense relating to its use of existing or new public facilities. A “capacity charge” does not include a commodity charge.

  • Access Charge has the meaning set out in Clause 6.1;

  • Monthly Charge shall have the meaning set forth in Article 5.

  • Management Charge means the sum paid by the Supplier to the Authority being an amount of half (0.5) percent of all Charges for the Services invoiced to the Contracting Bodies (net of VAT) in each Month throughout the Term and thereafter until the expiry or earlier termination of any Call-Off Contract;

  • Account Charge means, in relation to each of the Charged Accounts, the first priority fixed charge or pledge over all such accounts given or to be given by the relevant account holder thereof in favor of and in form and substance satisfactory to the Security Trustee.

  • Failed Bank Charge-Offs/Write-Downs means, with respect to any Shared- Loss Asset, an amount equal to the aggregate amount of reversals or charge-offs of Accrued Interest and charge-offs and write-downs of principal effected by the Failed Bank with respect to that Shared-Loss Asset as reflected on the Accounting Records of the Failed Bank.

  • transaction charge means any amount charged to a client by a registered firm in respect of a purchase or sale of a security and includes any federal, provincial or territorial sales taxes paid on that amount;

  • Room charge means the charge imposed for the use or occupancy of a room, excluding charges for food, beverages, state use tax, telephone service, or like services paid in connection with the charge, and excluding reimbursement of the assessment imposed by this act.

  • SLDC Charges means the charges levied by the SLDC of the state wherein the Solar Power Project is located;

  • Annual Service Charge for any period means the aggregate interest expense for such period in respect of, and the amortization during such period of any original issue discount of, Indebtedness of the Issuer and its Subsidiaries.

  • Monthly Charges means a finance carrying charge of one and one-half of one percent (1.5%) and a storage and handling charge of one-half of one percent (0.5%), in each case of the Cost of the Inventory and/or Special Inventory and/or of the fees for the Product affected by the reschedule or cancellation (as applicable) per month until such Inventory and/or Special Inventory and/or Product is returned to the vendor, used to manufacture Product or is otherwise purchased by Customer.

  • Facility Charge means one percent (1%) of the Maximum Term Loan Amount.

  • Connection Charge is the sum payable by the Communications Provider in accordance with the Openreach Price List for provisioning of the Service;

  • Annual Debt Service Charge as of any date means the amount which is expensed in any 12-month period for interest on Debt of the Company and its Subsidiaries.

  • Termination Charge means a charge levied when an unamortized balance remains and the Jurisdiction requests termination of Street Lighting Service. The charge is determined by costs of equipment, installation, removal, disposal, Capital Recovery Period, and Utility Financing Cost minus payments made to date for the specific fixtures.

  • User charge means a charge imposed on airlines for the provision of airport, air navigation, or aviation security facilities or services including related services and facilities.

  • Access Charges means the sum payable under the Access Agreement and/or this RAO agreed by the Operators to be paid by the Access Seeker to the Access Provider for providing the Access Service, the indicative Access Charges are as per Appendix C hereof which rate is exclusive of GST which shall be payable also by the Access Seeker.

  • Resource Substitution Charge means a charge assessed on Capacity Market Buyers in an Incremental Auction to recover the cost of replacement Capacity Resources.

  • Service Charges means the fees levied by the municipality in terms of its tariff policy for any municipal services rendered in respect of an immovable property and includes any penalties, interest or surcharges levied or imposed in terms of this policy.