302F00000X Taxonomy Code - Exclusive Provider Organization

Taxonomy Code

Code:
302F00000X

Type:
Managed Care Organizations

Classification:
Exclusive Provider Organization

Specialization:
N/A

Version:
NCCU Provider Taxonomy Version 16.1

Definition:
(1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations.

Level:
Level II - Classification


Related Taxonomy Codes

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization
1 302R00000X Health Maintenance Organization
2 305R00000X Preferred Provider Organization
3 305S00000X Point of Service


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This page was last updated on: 7/1/2016
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