Blue Cross and Blue Shield phrase that means the formal notice sent by a host plan from the home plan after the home plan has received the admission wire and verified membership information. This approval is given for a specific number of days and insurance contract benefits. See also admission wire.

1. Maximum dollar value the commercial private insurance company or managed care contract assigns to each procedure or service on which payment is based. Typically, a percent (e.g., 80%) of the allowed amount is paid by the insurance carrier. 2. Allowed amount based on the Medicare fee schedule or its transition rules, which may or may not be the same as the actual amount billed. The patient may or may not be responsible for the difference. Nonparticipating physician charges are subject to the limiting charge. 3. Also called the allowed amount or approved amount. See also Medicare-approved amount, maximum allowable, and maximum allowable charge (MAC).

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Amounts paid under health insurance as the maximum fee for a covered service.

1. Medical facility authorized to provide medical services and specific health care services stated in managed care contracts. 2. Hospital authorized to treat and admit beneficiaries of the Medicare program. Also known as approved health care hospital .

Medical program certified or endorsed to provide services to members of a managed care plan or beneficiaries of a federal program (e.g., Medicare, TRICARE).