How To Calculate Non-PAR Reimbursement

How To Calculate Non-Participating Reimbursement - Definition

Definition:

Non-PAR (Non-Participating Providers) is a providers who do not accept the agreement. So during the reimbursement they will get 5% less than PAR Providers.

Formula:
Total reimbursement = (allowable amount x 80% x 95%) - (patient 20% co-pay x 95%)
Example :

Calculate the total reimbursement for the Non-participating provider when the allowed amount is Rs.5000.

Solution:
Total reimbursement = (allowable amount x 80% x 95%) - (patient 20% co-pay x 95%)
= (5000 x 0.8 x 0.95) - (5000 x 0.2 x 0.95)
= 3800 - 950
= 2850

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