Provider Log In:

Register

Text Size: decrease text size   increase text size


We Want Your Feedback

Survey

Help us improve your online experience by taking a few minutes to give us your feedback.

Take the survey

 

going green

Healthy Practices Newsletter is
Going Green

Sign up today!

 

Contact Us

Contact Professional Relations or the Customer Care Center for Provider Services

 

More Contact Info

 

 

Credentialing

This information is intended for practitioners and facilities in the MVP and Hudson Health Plan service area, which includes most of New York and Vermont.  Please refer to the MVP Service Area maps to determine if you are within the MVP service area. Practitioners outside of this area may provide services to MVP members via the Cigna national network. If you are a provider outside of the MVP service area and are interested in joining the Cigna network, please visit the CIGNA website to learn more.

 

Credentialing FAQs

Q:  Who needs to be credentialed?
A:  Physicians (see exceptions under Practitioner Registration), Oral Surgeons, Podiatrists, Optometrists, Audiologists, Physical Therapists, Occupational Therapists, Speech/Language Pathologists, Certified Nurse Midwives, Certified Diabetes Educators, Registered Dieticians/Nutritionists and Behavioral Health practitioners need to be credentialed. There are additional credentialing requirements, specific by state, for Naturopaths and Athletic Trainers (Vermont only),  Nurse Practitioners who are independent in specialty areas approved by New York State Public Health Law and Nurse Practitioners in a physician practice with a PCP specialty who wish to practice as a PCP (New York only), and Advanced Practice Registered Nurses (Vermont only). In addition, certain facility types must also undergo credentialing. Please refer to the Facility Credentialing section of this page for details.

 

Note: Chiropractors, Acupuncturists and Massage Therapists are contracted and credentialed through an agreement with Landmark Health Care. Please visit Landmark Health Care for additional information.

 

All Behavioral Health practitioners and Behavioral Health facilities located outside of Vermont and the Hudson Health region are  contracted and credentialed through an agreement with ValueOptions®. Please visit ValueOptions for additional information.  

 

Behavioral Health providers and facilities that provide services in the Hudson Health Plan service area are contracted and credentialed through an agreement with Beacon Health Strategies.  Please visit Beacon Health Strategies for additional information.

 

Optometrists that provide wellness vision services in the Hudson Health Plan region are contract and credentialed through an agreement with Superior Vision. Please visit Superior Vision for additional information.

 

Note: Contracting and credentialing of healthcare practitioners may be limited by geographic need.

 

Q: How do I apply?
A:  All practitioners who require credentialing must complete the online Coalition for Affordable Quality Health Care (CAQH) Universal Credentialing Application®. To get started:

  • Determine if you already have a CAQH provider ID number.
  • Determine if you are joining an existing contract or will require a new contract with MVP.
  • Contact MVP Professional Relations at 1-888-363-9485 to be directed to the appropriate Professional Relations Representative in your area.
  • Provide your Professional Relations Representative with your CAQH provider ID number by calling 1-888-363-9485. Exception: West Region (Rochester/Buffalo): Please complete the CAQH Provider Data Formand fax it to 585-327-2289 to begin the credentialing process. If you are not covered under a group contract, please complete and return a Federal W-9 form.
  • Complete or update your CAQH online application. Be sure that you have listed MVP as an authorized plan. For assistance completing your CAQH application, please contact the CAQH Help Desk at 1-888-599-1771 or email your questions to caqh.updhelp@acsqs.com.

Getting Started with CAQH

CAQH Application Tips

 

Note: Simply adding MVP to the list of authorized plans on your CAQH application will not result in a request to be credentialed with MVP. In addition, completion of the CAQH application does not grant participation or constitute approval for network participation.

 

Q:  When will the credentialing process begin?
A: The credentialing process will not begin until MVP has been given access to a complete CAQH application (including current documentation of adequate malpractice insurance, current licensure, etc.) and the applicant has returned a signed contract (if applicable). Once the application has been determined to be complete, the MVP Credentialing Staff will begin primary source verification of education, licensure, training, etc. as per state and federal regulations.

 

Q:  When does the credentialing process end?
A:  The process is completed when all elements required by state and federal law have been verified and all required queries are complete. At that time, the application and verification will be presented to the MVP Credentials Committee for review and decision regarding participation.


Note: Credentialing applicants are not authorized to provide services to MVP members until they have been reviewed and approved for participation by the MVP Credentials Committee.  Practitioner effective dates will not be made retroactive prior to the Credentials Committee approval date.

 

Miscellaneous Credentialing Information

All practitioners are required to meet the minimum criteria for their specialty.  Criteria are available by contacting the MVP Credentialing Department at 1-888-363-9485.

 

General Credentialing Criteria

New practice offices/locations for physicians or nurse practitioners (NPs) providing primary care services (PCPs) and OB/GYNs will be required to undergo a practice site inspection, including a review of medical record keeping practices.

 

New York State Physicians Requesting HIV/AIDS Specialty Designation

Per the New York State Department of Health (NYSDOH), health plans are required to identify those physicians who have labeled themselves as HIV/AIDS Specialists and to list those physicians in MVP Directories.  Following the NYSDOH criteria, MVP has created an Identification and Notification of HIV/AIDS Specialist Attestation Questionnaire which physicians may complete and return to the MVP Credentialing Department.  Physicians who return the completed form and are found to meet the NYSDOH criteria will be listed in MVP directories under the additional specialty of HIV/AIDS Specialist. 

  

Identification and Notification of HIV/AIDS Specialist Attestation Questionnaire

 

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 re-credentialing 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/re-credentialing application.
  • The right to correct erroneous information submitted during the credentialing/ re-credentialing 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 re-credentialing application status. MVP Health Care, upon applicant’s direct verbal or written request, will notify him/her of the status of their application.

Provisional Credentialing of NYS Physicians

Per NYS law, New York State Applicants that are joining a participating group in which all members of the group already currently participate with MVP Health Care are eligible for provisional credentialing as of the 91st day of the application process in the following circumstances:

  1. He or she has submitted a completed application along with any requested supporting documentation;
  2. He or she has submitted a written request for provisional credentialing to the MVP Health Care Director of Credentialing and stated that should their application be denied, the applicant or their group practice:
    1. shall refund any payments made for in-network services provided during the period of provisional credentialing that exceed out-of-network benefits under the insured's contract with MVP Health Care; and
    2. shall not pursue reimbursement from the insured, except to collect the copayment or coinsurance that otherwise would have been payable had the insured received services from a participating MVP provider.

Practitioner Registration

The following practitioner types do not require credentialing but must be registered with MVP: Hospitalists (Internal Medicine, Pediatric or Family Medicine), Emergency Department Physicians, Pathologists, Anesthesiologists, Neonatologists, Certified Registered Nurse Anesthetists, Nurse Practitioners working in a physician practice who do not act in the capacity of a PCP, and Physician Assistants. 

 

Registration Form

 

Exceptions:  Anesthesiologists who want to be designated as Pain Treatment Specialists or Hospitalist physicians who also work outside of the inpatient setting must be credentialed.

 

All demographic changes for credentialed practitioners are handled by the Professional Relations Department at 1-888-363-9485 or complete and return the Provider Change Form located in Provider Forms.

 

Facility Credentialing

Facilities (organizational providers) who wish to participate with MVP Health Care should contact the Network Development Department at 1-877-736-5735 for information. The following facility types are required to be credentialed prior to participation with MVP:  ambulatory mental health and substance abuse treatment facilities, adult day health care centers (New York only), HIV/AIDS day care centers (New York only), bariatric surgery centers, federally qualified health care centers, free-standing ambulatory surgery centers, free-standing birthing centers (New York only), free-standing dialysis centers, free-standing radiology centers, free-standing rehabilitation centers (mental rehab and physical rehab only), home health agencies, including those agencies providing home infusion services and personal care assistant services, hospice, hospitals, hyperbaric medicine treatment centers, long-term care facilities, portable/mobile x-ray suppliers, psychiatric hospitals, residential alcohol/substance abuse treatment facilities, skilled nursing facilities, transplant programs, ventricular assistance device programs, and urgent care centers.

 

Facility Credentialing Criteria

 

Urgent Care Centers are required to submit a hospital transfer protocol to verify how they intend to ensure timely and adequate communication with the receiving hospital and PCP in the event a patient requires emergent transfer to a hospital.  A copy of the protocol should be submitted with the completed Hospital Transfer Protocol Cover Sheet.

 

Contact the MVP Health Care Credentialing Staff

To contact a member of the MVP Credentialing Department, please call 1-888-363-9485.