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nonparticipating provider

Defined in 7 places across 3 titles of the United States Code.

The term “nonparticipating provider” has the meaning given such term in section 1185e(a)(3) of this title.

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The term “nonparticipating provider” has the meaning given such term in section 300gg–111(a)(3) of this title.

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The term "nonparticipating provider" has the meaning given such term in section 9816(a)(3).

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The term "nonparticipating provider" means, with respect to an item or service and a group health plan, a physician or other health care provider who is acting within the scope of practice of that provider's license or certification under applicable State law and who does not have a contractual relationship with the plan or issuer, respectively, for furnishing such item or service under the plan.

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The term "nonparticipating provider" means, with respect to an item or service and a group health plan or group health insurance coverage offered by a health insurance issuer, a physician or other health care provider who is acting within the scope of practice of that provider's license or certification under applicable State law and who does not have a contractual relationship with the plan or issuer, respectively, for furnishing such item or service under the plan or coverage, respectively.

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The term "nonparticipating provider" means, with respect to an item or service and a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a physician or other health care provider who is acting within the scope of practice of that provider's license or certification under applicable State law and who does not have a contractual relationship with the plan or issuer, respectively, for furnishing such item or service under the plan or coverage, respectively.

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The terms “nonparticipating provider” and “participating provider” have the meanings given such terms, respectively, in subsection (a)(3) of section 300gg–111 of this title.

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  • 2020–present42 U.S.C. § 300gg-132The Public Health and Welfare · Balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating facilities · in this section