![]() ∼omplete Claim means, unless state law otherwise requires, an accurate Claim submitted pursuant to this Agreement, for which all Plan submitted by a provider for payment by a Plan for Health Services rendered to a Covered Individual. ∼laim means either the uniform bill claim form or electronic claim form in the format prescribed by Global Case Rate means the all inclusive Anthem Rate which includes facility, professional and physician services for specific Coded Rate means the all inclusive Anthem Rate for an entire admission or one outpatient encounter. Management services organization on a per member per month basis for either specific services or the total cost of care. ∼apitation means the amount of pre-payment made by Anthem to a provider or The Anthem Rate shall represent payment in full to Provider for Covered ∺nthem Rate means the lesser of ProvidersĬharges for Covered Services, or the total reimbursement amount that Provider and Anthem have agreed upon as set forth in the Plan Compensation Schedule (PCS). Blue Plan will have a current listing of suchĪffiliates available through a commonly available web site or upon request. Or any entity which is under common control with Blue Plan and that accesses the rates, terms or conditions of this Agreement, including but not limited to the entities listed on Exhibit A hereto. ∺ffiliate means any entity owned or controlled, either directly or through a parent or subsidiary entity, by Blue Plan, InĬonsideration of the mutual promises and covenants herein contained, the sufficiency of which is acknowledged by the parties, the parties agree as follows: doing business as Anthem Blue Cross and Blue Shield (hereinafter ∺nthem) on behalf of itself and as an agent for thoseĪffiliates listed on Exhibit A hereto, each of which is deemed to be a party to this Agreement and each of which, including Anthem, is referred to herein as ∻lue Plan, and Online Care Network P.C. Agreement (hereinafter ∺greement) is made and entered into by and between Anthem Insurance Companies, Inc.
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