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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.
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:
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.
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.
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.
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.
All practitioners have the following rights:
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:
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.
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.
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.
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.
To contact a member of the MVP Credentialing Department, please call 1-888-363-9485.