Last updated July 01, 2016 with Version 16.1
The Health Care Provider Taxonomy Code Set is a hierarchical code set that consists of codes, descriptions, and definitions. Healthcare Provider Taxonomy Codes are designed to categorize the type, classification, and/or specialization of health care providers.
The Health Care Provider Taxonomy code set is published (released) twice a year on July 1st and January 1st. The July publication is effective for use on October 1st and the January publication is effective for use on April 1st. The time between the publication release and the effective date is considered an implementation period to allow providers, payers, and vendors an opportunity to incorporate any changes into their systems.
(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.
The American Medical Association (AMA) holds the copyright© for the Health Care Taxonomy Code Set (Provider Taxonomy). The Provider Taxonomy is commercial technical data and/or computer data developed exclusively at private expense and provided "AS IS" without warranty of any kind. The AMA, NUCC, and NPIdb and its members shall NOT be responsible for any consequences, including liability or damage attributable to or related to any use, non-use, or interpretation of information contained or not contained in the Provider Taxonomy.More information can be found regarding Health Care Taxonomy Codes at NUCC.org