Health care professionals must notify EmblemHealth (and the HIP Network Services IPA, Inc., if applicable) within five business days after any change in office address, telephone number and/or office hours.
From time to time, regulatory agencies will audit Plans’ directories for accuracy and may impose fines and/or penalties when information is found to be inaccurate. Any fines/penalties received by the Plan or negative financial impact experienced by the Plan due to a Practitioner’s failure to notify the Plan of any required change listed above will be levied to the Practitioner in the amount equal to the fine/penalty.
Health care professionals doing business as primary care physicians must maintain office hours not less than two (2) days per week, eight hours per day, at each primary care office.
Glossary terms found on this page:
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.
The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.
A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.
A family physician, family practitioner, general practitioner, internist or pediatrician who is responsible for delivering or coordinating care. Also called a PCP.