302F00000X Taxonomy Code - Exclusive Provider Organization

Code

302F00000X

ClassificationExclusive Provider Organization
GroupingManaged Care Organizations
LevelLevel II - Classification
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.
NotesSource: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 15; (2) Glossary of terms used in managed care Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 58; (3) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.
VersionNCCU Provider Taxonomy Version 21.0 - January 2021

The code 302F00000X is the health care provider taxonomy code for exclusive provider organization grouped under managed care organizations. NPI records indicate a total of 2,593 registered providers whose primary or secondary taxonomy code is exclusive provider organization of which 90 are registered as females, 52 registered as males and 2,451 are organizations.

302F00000X is a level II taxonomy code "classification" used to specify a health care provider service or occupation related to the Provider Grouping. Taxonomy codes are self-selected by the health care provider. Their specialty is defined based on their education level and training. Taxonomy codes do not specify the actual services rendered by the health care provider.



The Health Care Providers Taxonomy Code dataset is © Copyright 2020 of the American Medical Association. The code set is designed for use in electronic health care transactions mandated under HIPAA.

The taxonomy codes are unique alphanumeric codes, ten characters in length. The codes are divided into three distinct "levels": Provider Grouping, Classification, and Area of Specialization. The code set levels are organized to allow navigating down from generic classification to a provider's most specific level of specialization.

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