Participating (PAR) - A doctor, hospital, group practice, nurse, nursing home, pharmacy, or other allied health professional or entity has agreed to accept a set fee for services provided to members of a specific health plan. A direct or indirect contractual arrangement with a managed care group to provide "In-Network" covered services to members. They receive re-imbursement of eligible charges directly from the carriers.
Non-Participating (NON-PAR) - A doctor, hospital, group practice, nurse, nursing home, pharmacy, or other allied health professional or entity that does not have a Participating Agreement with specific health plan. They provide out-of-network services to members. They may collect full charge(s) from the members at the time of service.
No comments:
Post a Comment