(1) “Allowed amount” means the contractually agreed upon payment amount between a carrier and a healthcare entity participating in the carrier’s network, excluding any member deductible, co-pay, or other obligation;
Emergency medical service: means the service used in responding to the perceived individual need for immediate medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury. See Tennessee Code 56-7-602
Healthcare entity: means : (A) Any healthcare facility licensed under title 33 or 68. See Tennessee Code 56-7-602
Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
(2) “Commissioner” means the commissioner of commerce and insurance;(3) “Comparable healthcare service” includes, but is not limited to:
(A) Physical and occupational therapy services;(B) Radiology and imaging services;(C) Laboratory services; and(D) Infusion therapy;(4) “Department” means the department of commerce and insurance;(5) “Emergency medical service” means the service used in responding to the perceived individual need for immediate medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury;(6) “Health plan” means health insurance coverage as defined in § 56-7-109;(7) “Healthcare entity” means:
(A) Any healthcare facility licensed under title 33 or 68; and(B) Any healthcare provider licensed under title 63 or 68;(8) “Healthcare service”:
(A) Means a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease;(B) Includes a prescription drug or device; and(C) Does not include an emergency medical service;(9) “Insurance carrier” or “carrier” means a health insurance entity as defined in § 56-7-109; and(10) “Shopping and decision support program” means the program established by a carrier pursuant to this part.
