Exclusive Provider Organization definition

Exclusive Provider Organization. (EPO) means a health insurance issuer’s or carrier’s insurance policy that limits coverage to health care services provided by a network of providers who are contracted with the issuer or carrier.
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Exclusive Provider Organization or “EPO” means a type of managed care health plan where
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Exclusive Provider Organization or “EPO” means a type of managed care health plan where members are not required to select a primary care provider or receive a referral to receive services from a specialist. EPOs will not cover care provided out-of-network except in an emergency.
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Examples of Exclusive Provider Organization in a sentence

  • See the “Prior Authorization, Care Management, Medical Policy and Patient Safety” section for more information.This attachment sets forth Covered Services and exclusions (services not Covered).We will retain any refunds, rebates, reimbursements or other payments representing a return of monies paid for Covered Services.Please also read “Attachment B: Other Exclusions.”How An Exclusive Provider Organization (EPO) Plan Works.

  • Note that in a few counties where access to HMOs is limited, a third option, Exclusive Provider Organization (EPO), is available.

  • If the Plan is a Health Maintenance Organization (HMO) or Exclusive Provider Organization (EPO) Plan, they are only eligible to enroll in the Plan if they meet the Plan's geographic service area criteria.

  • The District shall offer health insurance with at least one Exclusive Provider Organization (EPO).

  • The District shall offer health insurance with at least the following or substantially similar choices: One Exclusive Provider Organization (EPO) Premium payments shall be shared with the District paying the equivalent of seventy-five percent (75%) of the premium for the plan.

  • In this section, a Plan that pays providers based upon capitation is called a “Capitation Plan.” In the rules below, “provider” refers to the provider who provides or arranges the services or supplies and “HMO” refers to a health maintenance organization plan, and “EPO” refers to Exclusive Provider Organization.

  • In this section, a Plan that bases benefits on a negotiated fee schedule is called a “Fee Schedule Plan.” An HMO and Exclusive Provider Organization (EPO) are examples of network only plans that could use a fee schedule.

  • Effective October 1, 1997, payer type codes started to include Point-Of-Service Plan (POS) and Exclusive Provider Organization (EPO).

  • As of implementation of the changed plans in 2010, the only such plans are the Preferred Provider Organization (PPO) plan, the Exclusive Provider Organization (EPO) plan, and the Basic Exclusive Provider Plan (Basic EPO) with plan designs attached and identified as PPO, EPO and Basic EPO.

  • Exception: A loss of coverage resulting from nonpayment of premium, fraud or intentional misrepresentation of material fact shall not be a Triggering Event.HOW THE PLAN WORKS Exclusive Provider Organization (EPO) ProvisionsOscar NetworkThe Network for this Policy is the Oscar Network.


More Definitions of Exclusive Provider Organization

Exclusive Provider Organization. (EPO) means an Exclusive Provider Organization, as defined in California Code of Regulations, Title 10, Section 2699.6000(r).
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Exclusive Provider Organization or "EPO" means any arrangement, other than a health maintenance organization, limited health service organization, voluntary health services plans, or a DHCSP, under which the beneficiary receives no coverage or benefits when utilizing non-preferred providers, except when such an arrangement is shown to be in the best interest of the beneficiaries and has been expressly approved by the Director in writing. WC PPPs are not a form of EPO.
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Exclusive Provider Organization. (EPO) means an Exclusive Provider Organization, as defined in Section 2699.6000(r) of Title 10 of the CCR a health insurance issuer’s or carrier’s insurance
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Exclusive Provider Organization means a managed care plan organized as an insurer that provides access to nonemergency cover ed health care services only through a contracted panel of participating providers, whose reimbursement includes prepayment, withholds, capitation, or other risk-sharing arrangements;
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Related to Exclusive Provider Organization

  • Provider Organization means a group practice, facility, or organization that is:

  • Preferred Provider Organization or "PPO" means an entity through which a group of health care providers, such as doctors, hospitals and others, agree to provide specific medical and hospital care and some related services at a negotiated price.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Procurement organization means an eye bank, organ procurement organization, or tissue bank.

  • Health care organization ’ means any person or en-

  • Health maintenance organization means that term as defined in section 3501 of the insurance code of 1956, 1956 PA 218, MCL 500.3501.

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other entity administering the Medicaid program and a health care operation under which the health care operation agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

  • Religious organization means a church, ecclesiastical corporation, or group, not organized for pecuniary profit, that gathers for mutual support and edification in piety or worship of a supreme deity.

  • ADR Organization means The American Arbitration Association or, if The American Arbitration Association no longer exists or if its ADR Rules would no longer permit mediation or arbitration, as applicable, of the dispute, another nationally recognized mediation or arbitration organization selected by the Sponsor.

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Technology provider means a person who:

  • Member organization means any individual, corporation, limited liability company, partnership, or association that belongs to an association.

  • Internet Service Provider (ISP) means an Enhanced Service Provider (ESP) that provides Internet Services.

  • Review organization means a disability insurer regulated

  • Third Party Components means software and interfaces, licensed by RIM from a third party for incorporation into a RIM software product, or for incorporation into firmware in the case of RIM hardware products, and distributed as an integral part of that RIM product under a RIM brand, but shall not include Third Party Software.

  • Electric Reliability Organization or “ERO” means the organization that is certified by the Commission under Section 39.3 of its regulations, the purpose of which is to establish and enforce Reliability Standards for the Bulk Power System in the United States, subject to Commission review. The organization may also have received recognition by Applicable Governmental Authorities in Canada and Mexico to establish and enforce Reliability Standards for the Bulk Power Systems of the respective countries.

  • Third Party Agreement means an agreement with an Underwriting Third Party and/or a Claims Third Party.

  • Managed Care Organization (MCO) means a contracted health delivery system providing capitated or prepaid health services, also known as a Prepaid Health Plan (PHP). An MCO is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law. An MCO may be a Chemical Dependency Organization (CDO), Dental Care Organization (DCO), Mental Health Organization (MHO), or Physician Care Organization (PCO).

  • Local Service Provider (LSP means the LEC that provides retail local Exchange Service to an End User. The LSP may or may not provide any physical network components to support the provision of that End User’s service.

  • Hospital purchaser/provider agreement (HPPA agreement) means a negotiated agreement entered between the fund and the hospital for the cost of hospital treatment.

  • Quality improvement organization or “QIO” shall mean the organization that performs medical peer review of Medicaid claims, including review of validity of hospital diagnosis and procedure coding information; completeness, adequacy and quality of care; appropriateness of admission, discharge and transfer; and appropriateness of prospective payment outlier cases. These activities undertaken by the QIO may be included in a contractual relationship with the Iowa Medicaid enterprise.

  • Credit union service organization means an organization, corporation, or association whose membership or ownership is primarily confined or restricted to credit unions or organizations of credit unions and whose purpose is primarily designed to provide services to credit unions, organizations of credit unions, or credit union members.

  • Third Party Providers or “TPPs” means any payment service provider that provides payment services to you or someone else that concerns the Account, for example, an AISP (described in Clause 1(c) below).

  • Service Provider Materials means all works of authorship, products and materials [including, but not limited to, data, diagrams, charts, reports, specifications, studies, inventions, software, software development tools, methodologies, ideas, methods, processes, concepts and techniques] owned by, or licensed to, the Service Provider prior to the Commencement Date or independently developed by the Service Provider outside the scope of this Agreement at no expense to Transnet, and used by the Service Provider in the performance of the Services;