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has been performed and after Employer has been invoiced. Provider incentives may include <br />payment for services not otherwise covered under the Plan of Benefits. For Value -Based <br />Programs in other Blue Cross and Blue Shield Licensees service Areas see the "Inter -Plan <br />Programs" section in Exhibit B. Service Area is the geographic area in which a Licensee is <br />authorized to use the Association -owned brands. <br />"Allowed Amount" and "Allowable Charge" mean the amount BCBSF, its Designated <br />Agent or a Licensee of the Blue Cross and Blue Shield Association (`BCBSA") agrees to <br />pay a provider as payment in full for a service, procedure, supply or equipment. <br />Additionally: <br />a. The Allowed Amount shall not exceed the maximum payment, unless otherwise <br />required by applicable law; <br />b. The Allowed Amount for emergency services (including air ambulance services) <br />provided by non -participating or non -contracting providers, as well as non -Emergency <br />Services provided by non -participating or non -contracting providers at participating or <br />contracting hospitals, hospital outpatient departments, critical access hospitals, or <br />ambulatory surgical centers, will pay in accordance with applicable federal law; and, <br />c. In addition to the member's liability for benefit year deductibles, copayments and/or <br />coinsurance, the member may be balance billed by the non -participating or non - <br />contracting provider for any difference between the Allowed Amount and the Billed <br />Amount, except where prohibited by applicable law. <br />For covered items and services provided by non -participating or non -contracting providers <br />described in this Section II. A. (2), the Allowed Amount will be the Recognized Amount <br />(less any applicable benefit year deductible, copayment and/or coinsurance). If the non- <br />participating or non -contracting provider disputes such Allowed Amount and initiates a <br />30 -day open negotiation and/or independent dispute resolution ("IDR") process in <br />accordance with applicable federal law, BCBSF or its Designated Agent will have the <br />exclusive discretion and authority to administer such processes on behalf of the Group <br />Health Plan, including but not limited to negotiating and agreeing with the provider upon <br />a revised Allowed Amount for the claim(s) that BCBSF or its Designated Agent, in its sole <br />discretion, believes to be appropriate under the circumstances, and administering the IDR <br />process as necessary and appropriate, where applicable. BCBSF or its Designated Agent <br />will have no obligation to inform, confer with, or obtain the consent of Employer in <br />negotiating with the non -participating or non -contracting provider, agreeing upon a revised <br />Allowed Amount, or administering the open negotiation and/or IDR process in any way, <br />in accordance with this Section. For the avoidance of doubt, the provisions of this <br />Agreement apply to any damages, including a reasonable attorneys' fee (for attorneys <br />chosen by BCBSF), resulting from, arising out of, based on, or in connection with, any <br />claim relating to the administration or result of any such negotiation or IDR process. <br />Employer agrees that its exclusive liability, and agreement to hold BCBSF or its <br />Designated Agent harmless, for any and all claims amounts that are not reimbursed by any <br />Stop -Loss Insurance carrier that is not affiliated with BCBSF or its Designated Agent <br />includes any additional claims amount that may result from BCBSF's or its Designated <br />Agent's administration of any participating or non -contracting provider negotiation or IDR <br />process described in this Section. <br />Notwithstanding anything herein to the contrary, the member's liability for benefit year <br />