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A commercial insurance company or a managed care plan participating provider is a provider that is in network of participating providers. These providers can be doctors, nurses, dentists, or other practitioners.

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11y ago

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Do physicians have to have hospital privileges to be a participating provider?

Yes, physicians must have privileges at a hospital in order to participate in an insurance. If they do not have those privileges, the insurance company will not pay for care.


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What is a non-participating physician?

Non-participating physicians for a given health insurance company don't have a contract with that company. If you see a non-participating physician, you may have less or no coverage, depending on the structure of your insurance contract.


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What is the difference between the submitted amount and approved amount on an insurance claim?

The payment a participating provider agrees to accept for a service. The approved amount is decided by insurance company fee schedules, CPT® coding standards and generally accepted insurance reimbursement rules.


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How do you find a Doctor Who accepts assignment?

Typically, you find a doctor who accepts assignment from your insurance company by contacting your insurance company for a list of participating providers.