What is the difference between UCR and the PacificSource allowable fee?
UCR—or “usual, customary, and reasonable”—usually applies to services of nonparticipating or noncontracted providers. It’s the fee allowance we use to calculate benefits for dental providers and nonparticipating medical providers. The PacificSource allowable fee applies to services of contracted participating providers. It’s the reimbursement rate we’ve negotiated under our provider contract.
