What is a Non-Participating Provider?
(Revised 02/14/11) A non-participating provider is a health care provider who does not accept assignment on Medicare claims. These providers may charge more than Medicare’s approved amount but not more than the limiting charge. The limiting charge is 115 % of the Medicare approved amount. They also may collect full payment directly from the patient at the time of service. Medicare then pays the patient 80% of the approved amount, less any unmet portion of the Part B deductible. In Minnesota, the Minnesota Care Law requires doctors to bill at Medicare’s allowed charge. This law applies only for Minnesota residents who receive services from a doctor in Minnesota.
