The Eligibility and Benefits Inquiry in Availity enables users to submit patient benefit inquiries and receive detailed benefit information directly from MVP in real-time.

• Member Search — Saves time by enabling users to find and select the right MVP Member before checking eligibility and benefits
• Additional Benefits — Shown in Eligibility & Benefits Inquiry results, provided by MVP. Details, including copay, coinsurance, and deductible, vary

Claims & Encounters Application

The Claims & Encounters application lets users submit Professional (837P) and Facility (837I) claims electronically without third-party billing software. Users can save templates for repeat services or patients, submit secondary and tertiary claims, and send corrected or replacement claims by selecting Frequency Type “7 – Replacement of prior claim.”

Quick Claims Application

The Quick Claims application is designed for smaller practices seeing the same patients / providing the same services on a weekly / monthly basis. It can only be used to submit Professional Claims (837P). It provides a very concise claim form, and templates features that allow for fast claim submissions.

Requirements to use Quick Claims:

• The claim contains no more than 50 service lines and does not have any attachments.
• The claim has two or fewer diagnosis code pointers per service line.
  The patient has only one insurance carrier.
• The patient has agreed to allow the payer to pay the provider for services.
• The patient’s release of information is on file at the service provider or utilization review organization.
• The patient’s signature is on file using the authorization form for CMS-1500 claim form block 12 and 13.
• No ancillary claim or treatment information needs to be included.
• No additional claim information needs to be included, such as:
• EPSDT referral information
• Onset date information
• Workers’ compensation
• Hospitalization
• Anesthesia information
• Condition codes
• No additional service line level information needs to be included, such as:
  
  • Claim line notes
  • National drug codes
  • Durable medical equipment information
  • SME certificate of medical necessity information

The Claim Status application allows users to inquire on the status of previously submitted claims to track their progress and view detailed claim processing information, delivered straight from MVP.

• Additional Claim Status details via API call to MVP — MVP to provide additional claim processing information via an API call made when user submits claim status inquiry.