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Coverage includes how to contact MVP, the appeals process, behavioral health, claims submission methods (EDI and manual), claims adjustments, coordination of benefits, and credentialing steps for new participating providers. Also addresses customer care for provider services, durable medical equipment procedures, hospital billing questions, pharmacy routing, utilization and case management, and provider responsibilities tied to plan 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do the updated provider policies take effect?","Question",{"text":108,"@type":109},"Updated policies for the quarter are effective October 1, 2024.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How can claims be submitted electronically?",{"text":113,"@type":109},"Use the Electronic Data Interchange (EDI) options provided by MVP, including the EDI Payee ID 14165, and contact the EDI coordinators for EDI questions.",{"name":115,"@type":106,"acceptedAnswer":116},"Where should provider credentialing application materials be sent?",{"text":117,"@type":109},"Complete the Provider Credentialing Application Request form found on MVP’s website, then email it to MVPPR@mvphealthcare.com with the state and county included in the subject 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Policies  \nTable of Contents  \nContacting MVP Health Care  \nAppeals Process  \nBehavioral Health  \nClaims  \nCredentialing  \nInpatient and Outpatient Services  \nMVP Medicare Advantage Plans  \nMVP Network Vendors  \nMVP Plan Type Information  \nMVP’s New York State Government Programs  \nPharmacy Benefits  \nProvider Responsibilities  \nQuality Improvement  \nUtilization and Case Management  \nContacting MVP Health Care  \nClaims ......................................................................................................................................................................... 2  \nCoordination of Benefits (COB)........................................................................................................................... 3  \nCredentialing ........................................................................................................................................................... 3  \nCustomer Care Center for Providers.................................................................................................................. 3  \nDurable Medical Equipment (DME) ................................................................................................................... 3  \nHospital Billing Questions..................................................................................................................................... 4  \nPharmacy ................................................................................................................................................................... 4  \nProfessional Relations ............................................................................................................................................ 4  \nUtilization and Case Management ..................................................................................................................... 4  \nServices That Require a Referral for MVP Medicaid Managed Care ........................................................ 5  \nBehavioral Health .................................................................................................................................................... 5  \nClaims  \nClaims Submission  \nSending Claims Electronically  \nMVP offers several options for submitting claims electronically using an Electronic Data Interchange (EDI)  \n• MVP’s Payee ID is 14165  \n• For E DI questions, call MVP’s EDI coordinators at 1-877-461-4911 or via email at[ediservices@mvphealthcare.com](ediservices@mvphealthcare.com)  \nSending Claims Manually (CMS-1500 or UB-04)  \nSubmit claims for all products and Members to the following address:  \nMVP Health Care  \nAttn: Claims Department  \nPO Box 2207  \nSchenectady, NY 12301  \nClaims Adjustments or Appeal Requests  \n• Call MVP’s Customer Care Center for Provider Services at 1-800-684-9286  \n• For faster processing, go to [mvphealthcare.com](mvphealthcare.com) to submit claim adjustment requests. The status of online claim adjustments is also available through your Provider online accou nt.  \n• Initial Claim Adjustment forms should be submitted to the following address for all products and Members:  \nMVP Health Care  \nAttn: Claims Department  \nPO Box 2207  \nSchenectady, NY 12301  \n• Second Clinical Review Claims Adjustment forms should be submitted to the following address:  \nMVP Health Care  \nAttn: Operations Adjustment Team  \nPO Box 2207  \nSchenectady, NY 12301  \n• Appeals should be submitted to the following addresses:  \nMVP  \nI D \\#  \nAddress  \nNot  \nMed ically  \nNecessary  \nMV P Health Care  \nAttn: Me m ber Ap peals Departme nt 62 5 State Street  \nSc he nectady, NY 12 3 05  \n\n| No P rior A ut horizat ion\u003Cbr>Obtained /E ligibility ( exc ludes med ical necessity ap peals) | MV P Health Care\u003Cbr>Attn: Me m ber Ap peals Departme nt\u003Cbr>62 5 State St","cbCainQ2F0sthXz1","https://ap.wps.com/l/cbCainQ2F0sthXz1","pdf",9244591,323,"English","# Provider Policies\n## Contacting MVP Health Care\n## Appeals Process\n## Claims\n## Coordination of Benefits (COB)\n## Credentialing\n## Customer Care Center for Provider Services\n## Durable Medical Equipment (DME)\n## Hospital Billing Questions\n## Pharmacy\n## Utilization and Case Management","[{\"question\":\"When do the updated provider policies take effect?\",\"answer\":\"Updated policies for the quarter are effective October 1, 2024.\"},{\"question\":\"How can claims be submitted electronically?\",\"answer\":\"Use the Electronic Data Interchange (EDI) options provided by MVP, including the EDI Payee ID 14165, and contact the EDI coordinators for EDI questions.\"},{\"question\":\"Where should provider credentialing application materials be sent?\",\"answer\":\"Complete the Provider Credentialing Application Request form found on MVP’s website, then email it to MVPPR@mvphealthcare.com with the state and county included in the subject line.\"}]","MVP Provider Policies - Your guide to working with MVP Health Care | PDF",1789633584,113]