A participating provider is one who has signed a contract with the insurance company to accept the terms (of the allowed payment amount) for patients who have that type of insurance.

When you call a doctor, and they say they don't accept the type of insurance you have, it means they are not a participating provider for that insurance plan.

Instructions:

1. As an executive manager, what are some things to consider when deciding whether or not to become a participating provider with a particular payer?
2. How would you determine whether or not a particular contract serves your practice? Really think about the insurance plans, like HMOs, PPOs, and Government, to include Medicare (Part B and C), Medicaid, and Tricare.