Podiatry > Claims Submission Time Period and Payment Turnaround
Participating practitioners will receive payments for Market Share Points on or near the 25th of each month for claims processed by the end of the prior month. Claims processed after the last day of the month will be included in the following month, provided they are submitted within the contractual timeframes.
The initial date of service on a submitted claim will determine when the time period begins for the Market Share Payment episode of care, regardless of the EmblemHealth processing date.
Glossary terms found on this page:
An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.
A legal agreement between an individual member or an employer group and a health plan that describes the benefits and limitations of the coverage.
The date on which a service was rendered.
An organization comprised of individual physicians or physicians in group practices that contracts with the managed care organization on behalf of its member physicians to provide health care services. Also called an Independent Practice Association.
Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.