1. An exclusive provider organization (EPO) is best described as a plan that:

Covers care only from network providers except in emergencies

An EPO covers services only when received from network providers, except in emergencies.

2. Under a capitation arrangement in managed care a provider is paid:

A fixed amount per enrolled member regardless of services used

Capitation pays the provider a set amount per member per period, regardless of how much care each member uses.

3. A usual, customary, and reasonable (UCR) charge is used by insurers to:

Determine a fair payment level for a service in a geographic area

UCR reflects the prevailing charge for a service in an area and helps set the allowable payment.

4. Precertification (prior authorization) in a managed care plan requires the insured to:

Obtain approval before certain nonemergency services

Precertification requires advance approval for specified nonemergency procedures to confirm medical necessity.