07/20/2017

Emblem Health/HIP-Capitation Payments

I am a HIP provider. I see HIP/Emblem patients in my private office. Every month I used to receive a monthly capitation payment. Last month the check never arrived. I have noticed that Emblem has taken over and I am wondering if they did away with the capitation. I called EMBLEM to inquire and was given an email address to address the question of where the payment was and that was 2 weeks ago with no response. Can anyone provide insight?

Emblem Health was created in 2006 through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP). GHI and HIP have been operating as separate companies in the New York region since 1937 and 1947, respectively. It is correct that any questions regarding HIP capitation have to be directed to an email address.

To our knowledge, there have been no changes with the Market Share capitation program for podiatry for HIP patients, since Emblem Health took over the HMO. If new patients were seen that should have been included in a monthly payment, it is recommended that you call provider relations and have them research their payment ledgers, to confirm if a payment should have been made or if there is a payment delay.  

It is also possible that you will not receive a paper EOB and check, but rather an electronic EOB or payment. It is recommended that you look for the electronic payment and if not you must email them. Ex. We received a capitated HIP payment (paper) last month for Provider X, and an electronic payment for Provider Y. 

We will continue to monitor the changes and provide updates with any new information found.