Claim and Risk Adjustment Forms
Resubmit a Claim
Providers may submit unprocessed claims to MVP electronically. For corrections pertaining to processed claims, please resubmit electronically or forward a Claims Adjustment Request form to:
MVP Health Care, PO Box 2207, Schenectady, NY 12301
YME/YUV Denials + Generic Denials Message
Claims denied with remark codes “YME—Provider Tax ID/Address discrepancy” or “YUV—The tax ID and/or address billed are not on file for the NPI billed” indicate that the demographic information on the provider’s claim does not match MVP’s records.
Providers must update demographic information, address, tax ID information, new billing locations, or additional office locations with MVP by maintaining provider data in CAQH or by submitting a change request through MVP’s Online Demographic form.
Appeals Introduction
MVP is committed to delivering the highest quality health care and customer service to our Members. In instances where misunderstandings or differences of opinion arise, the MVP Appeal Process offers Members a dignified and confidential method to address and resolve these matters.
Recoveries and Overpayments
MVP adheres to the time frames established by relevant auditing agencies, which may review up to three years of claim data. There is no time limit for Provider-initiated refunds to MVP. Should overpayment to a Provider be identified by MVP or another authorized agency, MVP may initiate recovery efforts through claim adjustments as permitted by law and in accordance with our policy.
Claim Timelines
A complete and accurate claim, or "Clean Claim," is defined as a properly completed UB-04 or 02/12 1500 claim form that contains all necessary data for processing, free from errors or conflicting information. Claims must be submitted within 180 days of the date of discharge or the date of service rendered.
Claim Returned to Providers Letter
Providers who receive a “Claim Returned to Provider” letter, indicating incomplete fields necessary for a Clean Claim, must respond to the letter or submit a corrected claim in compliance with the Provider’s contractual adjustment guidelines. If a corrected claim or contact is made beyond the contractual timeframe, it will be subject to timely filing requirements as specified in the Provider contract and may be denied.
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.