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Appeals are submitted to the listed Member Appeals Department addresses depending on the appeal type.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},288513,1790136202,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,113,117,122],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social 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.........................................................................................................................2  \nMVP Plan Type Information ........................................................................................................7  \nCredentialing ............................................................................................................................24  \nProvider Responsibilities..........................................................................................................43  \nInpatient and Outpatient Services ..........................................................................................71  \nPharmacy  \nBenefits..................................................................................................................................... 79  \nBehavioral Health .....................................................................................................................91  \nMVP’s New York State Government Programs ....................................................................... 100  \nMVP’s Medicare Advantage Plans .......................................................................................... 154  \nUtilization and Case Management ......................................................................................... 165  \nClaims ..................................................................................................................................... 210  \nQuality Improvement .............................................................................................................225  \nAppeals Process......................................................................................................................236  \nMVP Network Vendors ...........................................................................................................260  \nThe Provider Resources Manual will be amended as the MVP operational polices change.  \nProvider Resource Manual | 1  \nContacting MVP Health Care  \nProvider Resource Manual | 2  \nContacting  \nMVP Health Care  \nClaims .........................................................................................................................................4  \nClaims Submission............................................................................................................4  \nClaims Adjustments or Appeal Requests..........................................................................4  \nCoordination of Benefits (COB) ..................................................................................................5  \nCredentialing ..............................................................................................................................5  \nCustomer Care Center for Members...........................................................................................5  \nDurable Medical Equipment (DME) ............................................................................................5  \nHospital Billing Questions ..........................................................................................................5  \nPharmacy ....................................................................................................................................5  \nProfessional Relations................................................................................................................5  \nUtilization and Case Management .............................................................................................6  \nServices That Require a Referral for MVP Medicaid Managed Care ..........................................6  \nBehavioral Health .......................................................................................................................6  \nProvider Resource 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Providers use MVP’s Payee ID 14165 and contact the EDI coordinators for EDI questions.\"},{\"question\":\"What address should providers use for sending claims manually (CMS-1500 or UB-04)?\",\"answer\":\"Send claims to MVP Health Care, Attn: Claims Department, PO Box 2207, Schenectady, NY 12301.\"},{\"question\":\"Where should providers send claim adjustment requests and appeals?\",\"answer\":\"Claim adjustment requests can be submitted online for faster processing, and the manual lists specific PO Box addresses for initial clinical review and second clinical review forms. Appeals are submitted to the listed Member Appeals Department addresses depending on the appeal type.\"}]","2021 Provider Resource Manual - Your guide to working with MVP Health Care | PDF",1789633576,92]