Procedure that is a part of a larger surgical procedure and needs a separate code (e.g., partial cystectomy vs. complete cystectomy). See separate procedure to learn the difference between partial and separate procedure. See also complete procedure to learn the difference between partial versus complete.

Stipulated dollar amount established for certain health care services while other services are reimbursed on a cost or fee-for-service basis.

State-licensed dentist who has signed a contract with an insurance plan to give dental services to the plan’s members.

1. State-licensed hospital that has signed a contract with an insurance plan to provide hospital services to the plan’s members. 2. Inpatient facilities that participate in the Medicare program.

Type of insurance provision in which the insured is entitled to receive policy dividends that reflect the difference between the premium charged and actual costs. Premiums are calculated to give some margin over the expected cost of the insurance protection. Also called participating policy.

Pharmacy that has signed a contract with an insurance plan to give medical services to the plan’s members.

1. A physician who contracts with an HMO or other insurance company to provide services to the plan’s members. 2. A physician who has agreed to accept a plan’s payments for services to subscribers (e.g., some Blue plans). Eighty percent of practicing American physicians are participating physicians. 3. Doctor or supplier who agrees to accept assignment on all Medicare claims. These physicians or suppliers may bill the patient only for the Medicare deductible and coinsurance amounts. Also called affiliated health care provider, participating provider, in-network provider, network provider.