What is “participating provider” in medical billing?

Participating Provider in Medical Billing

A participating provider is a healthcare professional or facility that has an agreement with an insurance company to provide services to insured patients at contracted rates.

Participating Provider in Medical Billing Explained

In medical billing, participating providers are part of an insurance plan’s network, meaning they must follow the insurer’s guidelines for reimbursement. Patients typically have lower out-of-pocket costs when seeing a participating provider.

For example, a patient with a PPO plan pays less to see a participating provider than an out-of-network provider.

Find common acronyms and abbreviations in Medical billing glossary.

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