118 Provider A professional or Facility licensed when required by law that gives health care services within the scope of that license, must satisfy our accreditation requirements and be approved by us, on behalf of the Employer. Details on our accreditation requirements can be found at https://www.anthem.com/provider/credentialing/. This includes any Provider that state law says we must cover when they give you Covered Services. Providers that deliver Covered Services are described throughout this Booklet. If you have a question about a Provider not described in this Booklet please call the number on the back of your Identification Card. Qualifying Payment Amount The median Plan In-Network contract rate we pay In-Network Providers for the geographic area where the service is provided for the same or similar services. Recognized Amount For Surprise Billing Claims, the Recognized Amount is calculated as follows: • For Air Ambulance services, the Recognized Amount is equal to the lesser of the Qualifying Payment Amount as determined under applicable law (generally, the median Plan In-Network contract rate we pay In-Network Providers for the geographic area where the service is provided for the same or similar services) or the amount billed by the Out-of-Network Air Ambulance service provider. • For all other Surprise Billing Claims, the Recognized Amount is the lesser of the Qualifying Payment Amount or the amount billed by the Out-of-Network Provider or Out-of-Network Facility; or the amount approved under an applicable All-Payer Model Agreement under section 1115A of the Social Security Act. Recovery Please see the “Subrogation and Reimbursement” section for details. Residential Treatment Center / Facility: An Inpatient Facility that provides multidisciplinary treatment for Mental Health and Substance Use Disorder conditions. The Facility must be licensed as a residential treatment center in the state in which it is located, satisfy our accreditation requirements, and be approved by us. The term Residential Treatment Center/Facility does not include a Provider, or that part of a Provider, used mainly for: 1. Nursing care 2. Rest care 3. Convalescent care 4. Care of the aged 5. Custodial Care 6. Educational care Retail Health Clinic A Facility that gives limited basic health care services to Members on a “walk-in” basis. These clinics are often found in major pharmacies or retail stores. Medical services are typically given by Physician Assistants and Nurse Practitioners.