PARTICIPATING PROVIDER

A provider that has contracted with an insurance carrier or Managed Care plan to provide health services to plan members. A physician or group of physicians can participate as single entity with insurance company. A physician or other medical provider has agreed to accept a set fee for services provided to members of a specific health plan. They are deemed to be “in-network”.
Agree to participate with an insurance program means Physician agrees:

To accept assignment for all claims he submits:
means the physician requests direct payment
from the insurance,
To accept insurance allowable as payment in full
for services regardless of the charge he makes,
To complete and file the claim forms for the
patient at no charge for the patient, and
Not to bill the patient for services determined by
the carrier to be not reasonable and necessary.