Participating Provider definition: Copy, customize, and use instantly
Introduction
The term "Participating Provider" refers to a healthcare provider, facility, or organization that has agreed to provide medical services under a contractual arrangement with an insurance company or healthcare network. It is essential for defining reimbursement terms, patient responsibilities, and network agreements.
Below are various examples of how "Participating Provider" can be defined in different contexts. Copy the one that fits your needs, customize it, and use it in your contract.
Definition of "Participating Provider" as a network-affiliated provider
This definition ties "Participating Provider" to an entity contracted with an insurer or healthcare plan.
"Participating Provider" means any physician, hospital, or healthcare facility that has entered into an agreement with the insurer to provide covered medical services to plan members at negotiated rates.
Definition of "Participating Provider" as a healthcare professional under contract
This definition connects "Participating Provider" to a professional delivering medical services under a managed care plan.
"Participating Provider" refers to any licensed healthcare professional who has agreed to provide medical services to members of a health plan under the terms of a contractual agreement.
Definition of "Participating Provider" as a preferred provider
This definition links "Participating Provider" to a preferred status within a healthcare network.
"Participating Provider" means any healthcare provider that is part of the insurer’s preferred network and agrees to accept negotiated rates for covered services.
Definition of "Participating Provider" as an in-network provider
This definition applies "Participating Provider" to healthcare providers offering services at discounted rates for plan members.
"Participating Provider" refers to a hospital, clinic, or physician that provides medical services to insured patients under a health plan’s negotiated terms, often resulting in lower out-of-pocket costs for the insured.
Definition of "Participating Provider" as a contracted medical service provider
This definition ties "Participating Provider" to a provider who has a contract with an insurer to deliver services under specified terms.
"Participating Provider" means a healthcare provider that has executed an agreement with the health plan to render covered services and accept reimbursement according to the plan’s fee schedule.
Definition of "Participating Provider" as an eligible service provider
This definition connects "Participating Provider" to eligibility for reimbursement under a healthcare agreement.
"Participating Provider" refers to a healthcare professional or entity that has met all qualifications and contractual obligations to be reimbursed for covered services under an insurer’s terms.
Definition of "Participating Provider" as a network-contracted hospital
This definition links "Participating Provider" to a hospital providing services under an insurance contract.
"Participating Provider" means a hospital or medical center that has entered into a service agreement with an insurer to offer medical care to policyholders at agreed-upon rates.
Definition of "Participating Provider" as a managed care participant
This definition applies "Participating Provider" to managed care plans.
"Participating Provider" refers to any healthcare provider who has agreed to the reimbursement rates and service guidelines established by a managed care organization.
Definition of "Participating Provider" as an insurance-approved medical provider
This definition ties "Participating Provider" to an insurer-approved service provider.
"Participating Provider" means a medical professional or healthcare institution that is recognized by an insurance company as eligible to provide covered services to its policyholders.
Definition of "Participating Provider" as a service provider within a preferred network
This definition connects "Participating Provider" to a preferred provider organization (PPO).
"Participating Provider" refers to a healthcare provider that is part of a preferred network and offers services at negotiated rates, reducing costs for insured patients.
Definition of "Participating Provider" as a state-approved provider
This definition links "Participating Provider" to government-regulated insurance networks.
"Participating Provider" means a healthcare provider that meets state and federal regulations to deliver medical services under an approved insurance network.
Definition of "Participating Provider" as a provider under a reimbursement plan
This definition applies "Participating Provider" to a provider eligible for direct payment.
"Participating Provider" refers to a medical service provider who has an agreement with an insurer for direct reimbursement for covered medical services.
Definition of "Participating Provider" as a member of an accountable care organization (ACO)
This definition ties "Participating Provider" to ACO arrangements.
"Participating Provider" means a healthcare provider that is a member of an accountable care organization and provides coordinated medical care under shared-risk agreements.
Definition of "Participating Provider" as a provider under Medicare or Medicaid
This definition connects "Participating Provider" to government health programs.
"Participating Provider" refers to any physician, hospital, or clinic that has an agreement with Medicare or Medicaid to provide covered healthcare services to beneficiaries.
Definition of "Participating Provider" as a telemedicine provider
This definition links "Participating Provider" to virtual healthcare services.
"Participating Provider" means any healthcare provider contracted with an insurer to offer telemedicine consultations under an established reimbursement structure.
Definition of "Participating Provider" as an emergency care provider
This definition applies "Participating Provider" to emergency medical services.
"Participating Provider" refers to an emergency medical service provider that has entered into a network agreement to provide urgent care to insured patients.
Definition of "Participating Provider" as a specialized care provider
This definition ties "Participating Provider" to specialty medical fields.
"Participating Provider" means a licensed specialist, such as a cardiologist or orthopedic surgeon, who provides care under an insurance contract at negotiated rates.
Definition of "Participating Provider" as a home healthcare provider
This definition connects "Participating Provider" to in-home medical services.
"Participating Provider" refers to a home healthcare agency or professional that offers in-home medical care and has a contract with an insurer for reimbursement.
Definition of "Participating Provider" as a behavioral health provider
This definition links "Participating Provider" to mental health services.
"Participating Provider" means a psychologist, psychiatrist, or licensed therapist who provides mental health services under an insurance network agreement.
Definition of "Participating Provider" as per health insurance agreement
This definition ties "Participating Provider" to its role within a health insurance network.
"Participating Provider" means a healthcare provider or facility that has entered into an agreement with the insurance company to provide medical services at negotiated rates.
Definition of "Participating Provider" as recognized by a managed care organization
This definition connects "Participating Provider" to a managed care setting.
"Participating Provider" refers to a physician, hospital, or other healthcare entity that is contractually bound to provide services to members of a managed care plan under agreed-upon terms.
Definition of "Participating Provider" as used in a PPO network
This definition links "Participating Provider" to preferred provider organizations.
"Participating Provider" means a healthcare professional or institution that has agreed to provide medical services at discounted rates to insured individuals within a Preferred Provider Organization (PPO) network.
Definition of "Participating Provider" as applied in an HMO plan
This definition applies "Participating Provider" to health maintenance organizations.
"Participating Provider" refers to a licensed medical professional or facility that is a member of a Health Maintenance Organization (HMO) and provides services to enrolled members under contract.
Definition of "Participating Provider" as designated by Medicare Advantage plans
This definition ties "Participating Provider" to Medicare services.
"Participating Provider" means a healthcare entity that has agreed to accept Medicare-approved amounts as full payment for covered services under a Medicare Advantage plan.
Definition of "Participating Provider" as defined in a state Medicaid program
This definition connects "Participating Provider" to Medicaid coverage.
"Participating Provider" refers to a healthcare provider that is enrolled in a state Medicaid program and agrees to offer services to beneficiaries in compliance with state and federal regulations.
Definition of "Participating Provider" in the context of a dental insurance plan
This definition links "Participating Provider" to dental networks.
"Participating Provider" means a licensed dentist or dental specialist who has entered into a contractual arrangement with a dental insurance company to provide covered services to policyholders.
Definition of "Participating Provider" in relation to behavioral health services
This definition applies "Participating Provider" to mental health coverage.
"Participating Provider" refers to a licensed therapist, counselor, psychiatrist, or behavioral health facility that is part of an insurance network and provides covered mental health services.
Definition of "Participating Provider" as applied to telemedicine services
This definition ties "Participating Provider" to virtual healthcare.
"Participating Provider" means a physician, nurse practitioner, or other healthcare professional who is authorized to provide telehealth services under an insurer’s telemedicine program.
Definition of "Participating Provider" in reference to an employer-sponsored health plan
This definition connects "Participating Provider" to employer benefits.
"Participating Provider" refers to a hospital, clinic, or healthcare professional that has agreed to provide medical services at negotiated rates under an employer-sponsored health plan.
Definition of "Participating Provider" in a network-tiered reimbursement model
This definition links "Participating Provider" to tiered healthcare coverage.
"Participating Provider" means a healthcare provider classified within a specific reimbursement tier, offering services at predetermined rates as per the insurer’s policy.
Definition of "Participating Provider" in an out-of-network billing policy
This definition applies "Participating Provider" to out-of-network reimbursement rules.
"Participating Provider" refers to a healthcare provider who has a direct contract with an insurer to offer services at negotiated rates, distinguishing them from out-of-network providers.
Definition of "Participating Provider" in relation to value-based payment models
This definition ties "Participating Provider" to performance-based healthcare reimbursement.
"Participating Provider" means a healthcare professional or facility that participates in a value-based payment arrangement, receiving compensation based on quality and efficiency measures.
Definition of "Participating Provider" in a student health insurance plan
This definition connects "Participating Provider" to university-sponsored health coverage.
"Participating Provider" refers to a physician, urgent care center, or hospital that provides medical services to students under a university-sponsored health insurance plan.
Definition of "Participating Provider" in a short-term health insurance policy
This definition links "Participating Provider" to temporary coverage plans.
"Participating Provider" means a medical professional or facility that has agreed to offer covered services to insured individuals under a short-term health insurance policy.
This article contains general legal information and does not contain legal advice. Cobrief is not a law firm or a substitute for an attorney or law firm. The law is complex and changes often. For legal advice, please ask a lawyer.