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What is the benefit of being a nonparticipating provider?
The nonparticipating provider may receive reimbursement for rendered services directly from their Medicare patients. They submit a bill to Medicare so the beneficiary may be reimbursed for the portion of the charges for which Medicare is responsible.
When a health insurance plan preauthorization requirements are not met by providers?
If a health insurance plans prior approval requirements are not met by providers? payment of the claim is denied.
What is a non participating provider?
Nonparticipating physicians, or NonPARs, are healthcare providers who have chosen not to enter into contractual agreements with insurance companies or government payers. They do not have predetermined fee schedules or agreed-upon reimbursement rates with the insurance companies.
Who is responsible for obtaining preauthorization?
Your health care provider can make the prior authorization request. If your provider submits the request, they will send the required information to your health plan. You may need to fill out forms for your providers office.
Why would a provider choose not to be a PAR?
If you feel that you need to be able to treat Medicare beneficiaries, either financially or personally, but dont want to wait for Medicare reimbursement (or denials), then being a Non-Par Provider might be a an option to consider regardless of the extra 15% you can bill.
Related Searches
aetna prior authorization form (pdf)Aetna prior authorization phone numberAetna non participating Provider appeal formAetna prior authorization toolAetna prior authorization phone number for providersAetna behavioral health provider servicesPrior authorization listAetna prior authorization provider portal
A nonparticipating provider is a provider involved in the Medicare program who has enrolled to be a Medicare provider but chooses to receive payment in a different method and amount than Medicare providers classified as participating.
Related links
42 U.S. Code 300gg132 - Balance billing in cases of non
42 US Code 300gg132 - Balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating facilities.
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