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  • Podiatry > Termination from the Program

    If the podiatrist discontinues patient care prior to the expiration of the six-month care period, the podiatrist still receives the full MSP. If there is a pattern of discontinuation of care, EmblemHealth may determine a reduced reimbursement amount for the practitioner.

    Podiatrists who do not wish to participate under MSP shall have the option of terminating their agreement with HIP upon 180 days written notice or as otherwise described in their provider agreement. Upon notice to EmblemHealth of intent to terminate, practitioners should no longer accept new members who are covered under this program and will be expected to provide ongoing care for existing patients until the completion of their current treatment plan. After termination, these practitioners should desist from rendering service to HIP members except for continuity of care requirements as outlined in the provider agreement.

    For more information about the Market Share Payment program, please contact the Physician Contracting hotline at 1-866-447-9717.

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    Glossary terms found on this page:

    A legal agreement between an individual member or an employer group and a health plan that describes the benefits and limitations of the coverage.

    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.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

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