Liability Calculation Method Per Claim. The calculation of Participant liability on claims for covered health care services incurred outside the geographic area Blue Shield serves, and processed through BlueCard will be based on the negotiated price Blue Shield pays the Host Blue. The calculation of County liability on claims for covered health care services incurred outside the geographic area Blue Shield serves, and processed through BlueCard will be based on the negotiated price Blue Shield pays the Host Blue. The methods employed by a Host Blue to determine a negotiated price will vary among Host Blues based on the terms of each Host Blue’s provider contracts. The negotiated price paid to a Host Blue by Blue Shield on a claim for health care services processed through BlueCard may represent:
Appears in 2 contracts
Sources: Claims Administration and Cost Management Services Agreement, Claims Administration and Cost Management Services Agreement