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Is the relevant Medicare rate both the 'floor' and 'ceiling' for health plan payments to eligible providers for eligible services under CMS 2370-F?

The applicable Medicare rate does effectively become the "floor" for payments to eligible providers for eligible services, but not the "ceiling." Health plans may pay above that rate depending on their specific contractual arrangements with providers.

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Date
Sub Topic
FAQ ID
94246
FAQ Question
Is the relevant Medicare rate both the 'floor' and 'ceiling' for health plan payments to eligible providers for eligible services under CMS 2370-F?