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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, and behavioral health practitioners. There are additional credentialing requirements, specific by state, for naturopaths and athletic trainers (Vermont only), independent nurse practitioners (New York only), and advanced practice registered nurses (Vermont and New Hampshire only). In addition, certain facility types must also undergo credentialing. They are 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 Hampshire 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.
Important: Chiropractors, acupuncturists and massage therapists are contracted and credentialed through a delegation agreement with Landmark Health Care. Please go to Landmark Health Care for additional information.
All behavioral health practitioners and behavioral health facilities located outside of Vermont are contracted and credentialed through a delegation agreement with ValueOptions®. Click here for more information about ValueOptions®.
Please note that 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 please do the following:
Important: If you already have a CAQH number you must communicate that number and your desire to join MVP via the Professional Relations Department in your region or, in the Rochester/Buffalo area, by completing and faxing your CAQH Provider Data Form to 585-327-2289. MVP must add your name to their CAQH provider roster. Just 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 credentialing process begin?
A: The credentialing process will not be started 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 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 file will be presented to the Credentials Committee for review and decision.
Important: Credentialing applicants are not authorized to provide services to MVP members until they have been reviewed and approved by the MVP Credentials Committee. Practitioner effective dates will not be made retroactive prior to the Credentials Committee approval date.
Per the New York State Department of Health (NYS DOH), health plans are required to identify those physicians who have identified themselves as HIV/AIDS Specialists and to list those physicians in MVP Directories. Following the NYS DOH 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 NYS DOH criteria, will be listed in MVP directories under the additional specialty of HIV/AIDS Specialist.
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: Hospitalists (Internal Medicine, Pediatric or Family Medicine), Emergency Department Physicians, Pathologists, Anesthesiologists, Neonatologists, Certified Registered Nurse Anesthetists, Nurse Practitioners, Registered Dieticians, Registered Nutritionists and Physicians Assistants. Download the Registration Form .
Exceptions: Anesthesiologists who want to be designated as Pain Treatment specialists or Hospitalist physicians (other than Pathologists) who also work outside of the inpatient setting must be credentialed.
Demographic Changes for Credentialed Practitioners:
All demographic changes are handled by the Professional Relations Department at 1-888-363-9485 or complete and return the Provider Change Form located in the Provider Forms section.
Facilities and organizations who wish to participate with MVP Health Care, call 1-877-736-5735. Upon commencement of the contracting process, Network Management will provide the facility with an “Application for Participation for MVP Health Care Organizational Providers” form for completion and return. View facility credentialing criteria.
Urgent Care Centers and Anesthesiology groups providing anesthesia for office-based surgery are required to submit a hospital transfer protocol to verify how they intend to ensure timely and adequate communications 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 Health Care Credentialing, please call 1-888-363-9485.