Participating Provider Law and Legal Definition

Participating provider means a provider who has agreed to provide health care services to enrollees. It includes a hospital, doctor, pharmacy, group practice, nurse, nursing home, pharmacy, or other allied health professional or entity. A participating provider must be licensed in the state of provision and must be contracted with an insurer. Participating providers undertake to hold such enrollees harmless from payment with an expectation of receiving payment, other than copayments or deductibles, directly or indirectly from the health maintenance organization.