PAR Providers
Participating provider – A provider (e.g., hospital, group practice, health care facility or individual Clinician) who has a participation agreement in effect with Oxford to render medical services to covered persons in a particular Oxford Plan and network (e.g., Oxford Freedom Plan).
“Participating Providers” accept assignment from Medicare. The provider bills Medicare at their usual and customary fee; however, Medicare pays the provider 80% of the “allowed amount” for each CPT code. Patients are responsible for 20% of the allowed amount and this 20% should not be waived. The provider cannot bill patients for amounts in excess of the allowed amount and must write off the difference between the allowed amount and usual and customary fees.
