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The manual outlines how providers submit claims electronically via EDI or manually using standard claim forms, how to request timely processing, and where to send different categories of requests. 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......................................................................................................2  \nMVP Plan Type Information ........................................................................................................7  \nCredentialing ............................................................................................................................26  \nProvider Responsibilities..........................................................................................................45  \nInpatient and Outpatient Services ..........................................................................................71  \nPharmacy Benefits ...................................................................................................................79  \nBehavioral Health .....................................................................................................................91  \nMVP’s New York State Government Programs ....................................................................... 121  \nMVP Medicare Advantage Plans............................................................................................. 159  \nUtilization and Case Management ......................................................................................... 170  \nClaims ..................................................................................................................................... 215  \nQuality Improvement .............................................................................................................230  \nAppeals Process......................................................................................................................241  \nMVP Network Vendors ...........................................................................................................264  \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 Providers ..........................................................................................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 Manual | 3  \nContacting Table of Contents  Main T","cbCaisnBLkXQjADA","https://ap.wps.com/l/cbCaisnBLkXQjADA","pdf",3215874,267,"English","# Contacting MVP Health Care\n## Claims\n### Claims Submission\n### Claims Adjustments or Appeal Requests\n### Coordination of Benefits (COB)\n## Credentialing\n## Provider Responsibilities\n# Appeals Process","[{\"question\":\"How can providers submit claims to MVP Health Care?\",\"answer\":\"MVP supports electronic claims submission through EDI and also allows manual submission using standard claim forms such as CMS-1500 or UB-04. Providers must follow the specified instructions and destinations for each method.\"},{\"question\":\"Where should providers send claims adjustment requests or appeals?\",\"answer\":\"Claims adjustment forms and appeals have specific addressees and teams. The manual lists separate submission addresses for initial claims adjustment, second clinical review adjustments, and member appeals by category.\"},{\"question\":\"What is included in the credentialing guidance for providers?\",\"answer\":\"The credentialing section explains how providers can become participating providers by completing the Provider Credentialing Application Request form.\"}]","Provider Policies - Provider Resource Manual - Effective April 1, 2023 | PDF",93]