Important Note: The information on this Web page is for MVP network area providers.

Credentialing Application Process

MVP replaced its paper credentialing application with the online CAQH Universal Credentialing DataSource application for credentialing and recredentialing. This free, online service allows providers to complete one application to meet the credentialing needs of multiple organizations. Providers who have not registered with CAQH will be phased in during the recredentialing process. All credentialing applicants must use the online CAQH application to apply for MVP participation.

The ways Universal Credentialing DataSource can benefit your practice:

  • Saves time by eliminating the need to fill out redundant credentialing forms;
  • Saves money by reducing the need for credentialing software or services;
  • Minimizes recredentialing paperwork by allowing online updates;
  • Ensures data stays current for credentialing, health plan records, and directories; and
  • Helps offices work more efficiently, allowing practitioners more time for patient care.

Click here for more information on getting started with CAQH.

Special Notations:

MVP will not be able to access your application until CAQH has determined the application is complete. MVP performs primary source verification of the information provided. Contact the MVP Professional Relations Department at 1-888-363-9485 to obtain the necessary contracts.

If you have completed your CAQH application, ensure that you have authorized all applicable organizations to access your data. Please note that you control your own data. Health plans are not authorized to make any changes to your application.

Using CAQH Universal Credentialing DataSource does not grant participation or constitute applying for participation with any organization. Contact MVP Health Care directly for contracting information. If you are already registered with CAQH, please ensure that you have authorized MVP access to your credentialing information. If MVP does not appear on your authorization tab, please contact MVP Professional Relations at 1-888-363-9485.

For more information about the Universal Credentialing DataSource, visit http://caqh.geoaccess.com/oas/ or call the CAQH Help Desk at (888) 599-1771 or e-mail help@caqh.geoaccess.com.

Click here for more CAQH application tips.

When reviewing and updating your CAQH application, please ensure that you have provided the following information:

  • The effective dates of hospital privileges, a list of all previous hospital affiliations, and an explanation for hospitals with which you are no longer affiliated;
  • Patient status for all malpractice cases;
  • “Tail coverage” and second layer of liability information for professional liability insurance;
  • A minimum of ten years of work history and explanation for any gap of one month or more;
  • Answers for any new or modified disclosure questions upon completion of an initial application or reattestation; and
  • The expiration dates on license, DEA, board certification, and malpractice insurance. If these documents have expired since your last reattestation to your application, fax the copies of the new documents to CAQH.

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Instructions for All Credentialing Applicants

  1. Applicants are required to meet the minimum criteria for their specialty. Criteria are available by contacting the MVP Health Care Credentialing Department.
  2. Applicants must supply a completed federal W-9 form and submit it to the Professional Relations Department.
  3. Applicants must submit a signed and unaltered contract for participation, which can be obtained from the Professional Relations Department.
  4. New practice offices or locations for all PCPs, OB/GYNs or high volume behavioral health practitioners are required to undergo a practice site assessment, including a review of medical record keeping practices.
  5. Upon receipt of the completed CAQH application, federal W-9 form, and applicable contracts, MVP Health Care staff will begin the primary verification process.

Note: You are not authorized to render services to MVP Health Care members until you have been notified in writing of your approval of participation. This notification will include your provider number and effective date.

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General Credentialing Criteria

  1. A completed CAQH online application, which contains a signed and current attestation statement and release is required for initial credentialing and at recredentialing. A signature stamp is not acceptable.

    The credentialing and recredentialing application contains a current and signed attestation regarding:

    • Reasons for any inability to perform the essential functions of the position, with or without accommodation;
    • Lack of present illegal drug use;
    • History of loss of license and felony convictions;
    • History of loss or limitation of privileges or disciplinary activity;
    • Current malpractice insurance coverage; and
    • The correctness and completeness of the application.

    Applicants must be able to perform the essential functions of the position, with reasonable accommodation, and be free of present illegal drug use. Applicants with a history of license limitations, sanctions, felony convictions, loss or limitations of privileges or disciplinary actions, will be requested to submit, in writing, specific information prior to review by the Credentials Committee.
  2. Applicant is obliged to provide MVP with information sufficiently detailed to render an opinion regarding any adverse action taken by a State or Federal agency, another Institution such as the New York State Education Department (NYSED), New York State Office of Professional Medical Conduct (OPMC), US Office of Personnel Management (OPM), or any other applicable regulatory or professional body or any other items on the application as requested by MVP.
  3. MVP will obtain a minimum of six years work history from each applicant and review gaps of six months or more with the practitioner. Gaps of six months to one year may be explained via telephone and documented on the CV or application. Applicants must fully document in writing any gaps longer than one year in their work history.
  4. Credentialing staff will conduct verifications 180 days prior to the Committee’s decision including but not limited to:
    • License Status and registration;
    • License Sanction Activity;
    • Sanction Activity;
    • Board certification status;
    • DEA certificate for each state where the practitioner is treating MVP members;
    • Participation in Medicare;
    • Education and completion of residency and/or specialty training;
    • Proof of malpractice insurance coverage in the minimum coverage amounts of $1 million per incident and $3 million per aggregate;
    • Information relating to malpractice settlements or actions;
    • Unrestricted, active clinical privileges at an MVP participating hospital, if applicable; and
    • Federal National Practitioner Identification number (NPI number).

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Practitioner Rights

All practitioners have the following rights:

  • The right to review information received in support of their credentialing application.
  • Applicants have the right to review the information obtained from any outside primary source that is presented to the Credentials Committee in support of their credentialing and/or recredentialing application. For example, malpractice insurance carriers, state licensing boards, and hospitals. Recommendations, letters of reference and other peer review protected information are not subject to this disclosure. (Note: Disclosure of NPDB documentation can only be released directly to the Practitioner.)
  • Upon receipt of an applicant’s written, signed and dated request, MVP will release under confidential cover to the applicant by Delivery Confirmed or Certified Mail, Return Receipt Requested the information that is presented to the Credentials Committee in support of their credentialing/recredentialing application.
  • The right to correct erroneous information submitted during the credentialing/ recredentialing process. Should the Credentialing Staff receive information that differs substantially from the information provided by the practitioner, a member of the Credentialing Management staff will notify the practitioner, in writing, of the discrepancy.
  • The right to be informed of their credentialing or recredentialing application status.

MVP Health Care, upon applicant’s direct verbal or written request, will notify him/her of the status of their application.

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Contact the MVP Health Care Credentialing Staff

Credentialing Staff: 1-888-363-9485
Credentialing Fax: 518-386-7200

Hours of Operation:
Monday-Friday
8:30a.m.-5p.m.

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