Termination of a Participating Chiropractor Agreement

Under the provisions of the HMSA Participating Chiropractor Agreement (Section VII), a chiropractor or HMSA may terminate the contract. The procedures for termination are explained below.

Chiropractor Terminates Participating Chiropractor Agreement

A chiropractor may terminate the contract with HMSA with or without cause. The chiropractor is responsible for notifying members and HMSA of his or her termination decision.

Notifying members

Chiropractor is required to give HMSA members at least 60 calendar days' written notice prior to terminating the Participating Chiropractor Agreement.

Notifying HMSA

When a chiropractor chooses to terminate the contract with HMSA, he or she must give HMSA 60 calendar days' written notice. HMSA will send the chiropractor a confirmation letter upon receiving the chiropractor's notice of termination. This letter will provide information on claims filing and payment options related to continuity-of-care issues.

HMSA Terminates Participating Chiropractor Agreement

HMSA may terminate the chiropractor's agreement if the chiropractor does not comply with the agreement provisions, including those related to credentialing (refer to Provider Credentialing Requirements). In these cases, HMSA may terminate a chiropractor's contract for cause with 60 calendar days' written notice.

If the chiropractor's license to practice in the state of Hawaii has expired or been revoked, suspended, limited or conditioned, HMSA may terminate the agreement immediately upon written notice to the chiropractor.

Note: If you have been excluded as an eligible chiropractor for federal programs, this may or may not be grounds for termination of the HMSA Participating Chiropractor Agreement, depending on the circumstances. (HMSA's Credentialing Committee on a case-by-case basis reviews such occurrences.) A chiropractor who is barred from providing services to Medicare patients may not provide services to members of HMSA's federally funded plans (e.g., 65C Plus, Federal Plan 87, HMSA Plan for Postal Service Employees, the Federal Employee Program, The HMSA Plan for QUEST Members and Medicaid).

Appealing a termination

If a chiropractor decides to appeal HMSA's termination of the HMSA Participating Chiropractor Agreement, the appeal must be made in writing within 60 calendar days of the receipt of HMSA's written termination notice.

HMSA will convene a review committee within 30 calendar days of receiving the chiropractor's written request for an appeal. Any individual who was involved in the original review of the case or any individual who has financial interest in the outcome of the case may not sit on the committee. The committee will select one of its members to act as chairperson.

The chiropractor may appear to present evidence or testimony before the committee. HMSA or the chiropractor may be represented by an attorney or by another representative at the appeal of a termination.

The committee will either uphold or reverse the termination decision and notify the chiropractor of its determination within five working days. If the committee upholds the termination decision, the letter will give the chiropractor information about the arbitration process. Arbitration is the final avenue of appeal.

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