Behavioral Health
MVP takes pride in partnering to support the behavioral health needs of our Members—your patients. This section is dedicated to offering you the resources and information necessary when working with MVP.
Resources and Information
Education and Attestations
Providers are frequently expected to complete various training sessions and formally confirm their participation. Please consult our training library and attestations for more information.
Behavioral Health Forms
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NYS Child Health Plus (CHP) Program
Children’s Home and Community Based Service Forms
- CHP Form when requesting an initial HCBS service request for children
- CHP Form when requesting a continuation of HCBS service(s) for children
Health Home Entity
- Health Home entity form when referring CHP Members for HCBS Services, intended to be given to HCBS providers to review
- Health Home entity form used to determine HCBS eligibility for MF HCBS ages 0-5
- Health Home entity form used to determine HCBS eligibility for MF ages 6-19
- Health Home entity form used to determine HCBS eligibility for SED ages 0-5
- Health Home entity form used to determine HCBS eligibility for SED ages 6-19
- Health Home entity form for use by LPHA’s when requesting HCBS eligibility Assessment
Medically Fragile Target Population
(only required if SSI certification or DOH disability Review Team Certification with valid coverage dates is not available):
- Childhood Medical Disability Report (DOH 5151)
For use by child’s doctor to assist in determining Medicaid eligibility based on a disability, after an application for benefits has been filed. - Description of Child’s Activities (DOH-5153)
For use by Members to assist in determining Medicaid eligibility based on a disability, after an application for benefits has been filed. - Disability Questionnaire (DOH 5 39)
For use by Members when requesting Eligibility assessment from Health Home entity. - Questionnaire of School Performance (DOH-5152)
For use by the child’s teacher or school administrator to assist in determining Medicaid eligibility based on a disability and physical or mental limitations on a child’s ability, after an application for benefits has been filed.
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Prior Authorization, Admission, and Notification Forms
Be sure to look over all the forms you'll need while working with MVP.
- ABA Authorization Request
For requesting authorization for Applied Behavioral Analysis Assessment and Treatment. - Authorization to Disclose Information
For Members to complete if they wish to give MVP permission to discuss their health with another person. - Behavioral Health Outpatient Treatment Request
For use by Providers located in New York requesting authorization for outpatient mental health and/or substance use treatment. - Children’s Home and Community Based Service Notification Form
For use by Children’s Home and Community Based Service (HCBS) providers when requesting an initial HCBS service request for children. - CORE Overview
Please review the LPHA Recommendation forms and the CORE Provider Service Initiation template under the Resources & Guidance section. - Health Home Adult Enrollment Referral
Used to refer eligible adults for Health Home services. - Mental Health Treatment Notification of Admission
For use by hospitals and facilities when an adult, age 18+, is admitted for Inpatient Mental Health and for admissions to Mental Health Residential Treatment Centers for members of all ages. - Prior Authorization Request Form Vermont
For use by Providers located in Vermont requesting authorization for mental health and/or substance use treatment. - Substance Use Disorder Two Business Day Notification and Initial Treatment Plan
For use by hospitals and facilities when a member is admitted for Inpatient and/or Residential Substance Use Treatment. - Two-Day Notification and Initial Treatment Plan
For use by hospitals and facilities when a child/adolescent, age 0-17, is admitted for Inpatient Mental Health.
- ABA Authorization Request
Provider Compliance
Update Your Access & Availability (Required Quarterly)
As an MVP Participating Provider, you must meet regulatory Access and Availability standards. Providers can update their panel status to reflect whether they are accepting new patients by modifying the relevant field in the CAQH Provider Data Portal and re-attesting their demographic information. Each re-attestation sends updated information to MVP, ensuring Members have current details about your practice.
Credentialed Providers
Credentialed Providers should regularly update and attest to their demographic details in the CAQH Provider Data Portal, which automatically syncs with MVP systems. Information received includes practice address, contact info, specialties, panel status, and languages. Updates like billing address, specialty changes, provider name, or new product lines must be submitted via the Provider Change of Information form with documentation. Behavioral Health Providers are encouraged to complete all relevant CAQH sections to help MVP Members find care.
Registered Providers
Registered Providers must keep their MVP information updated, including demographics, hours, participation status, and panel changes. Notify MVP promptly about group moves, payment details, specialty/category changes, or new product lines. Submit demographic updates online using the Provider Change of Information form, which supports uploads for group changes. Accurate Provider data ensures compliance with Health Access Standards and helps MVP Members find care efficiently.
Attac Consulting Group
MVP works with Attac Consulting Group to verify the accuracy of Provider demographic details and appointment availability shown on the Find a Doctor tool. Some Providers may be contacted by phone or fax and are asked to confirm or return the requested information to help ensure members have reliable access to care.
Didn’t Find What You’re Looking For?
Most routine provider tasks can be completed through Availity self‑service. Use Availity to submit and check prior authorizations, verify member eligibility and benefits, review claim status, and access payment and remittance information—all in one place.