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In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
A: This depends on your insurance provider's policies and enrollment periods. Typically, you can switch during the open enrollment period or if you qualify for a special enrollment period due to a ...
Despite a perception that IPAs have been formed to negotiate as a group with insurance companies in an attempt to improve rates of compensation, under the Federal Trade Commission Act, they cannot negotiate as a group with insurance companies for the providers' other insurance reimbursement. The IPA can only negotiate for the IPA members those ...
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
For many, health care plan abbreviations like HMO, PPO, EPO, and PPS are just alphabet soup. Doctors and Clinicians analyzed KFF data and resources from the Department of Health and Human Services ...
In 1970, the number of HMOs declined to fewer than 40. Paul M. Ellwood Jr. , often called the "father" of the HMO, began having discussions with what is today the U.S. Department of Health and Human Services that led to the enactment of the Health Maintenance Organization Act of 1973 .
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...
A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive payments for their services rendered from health insurance providers.