Get up-to-date information that will help strengthen our partnership. This section includes updates on MVP policies, programs, and changes that impact you as you do business with MVP.

  • Cybersecurity: Protect Your Data Against Threats

    Cybersecurity: Protect Your Data Against Threats

    Published April 2022

    MVP places great importance on information security to protect against internal and external threats. Our cybersecurity strategy prioritizes detection, analysis, and incident response to cyber threats, vulnerability management, and resilience against cyber incidents. MVP continuously strives to meet and exceed the industry’s information security best practices and applies controls to protect our Provider partners and our Members. As a strategic partner, we want to remind you of some basic questions to ask yourself before clicking on emails that come from an unknown source:

    • Do you recognize the sender’s email address?
    • If you know the sender, were you expecting this email?
    • Does the message contain poor spelling or grammar?
    • Does the message ask for personal information?
    • Does the offer seem too good to be true?
    • Did you initiate the action?
    • Are you being asked to send money? 
    • Does the message make unrealistic threats? 
    • Does the message appear to be from a government agency like the IRS?
    • Does anything look off?

    Please be sure to remind your staff to ask themselves these questions and to stay vigilant against cyberattacks.


  • Helping to Improve Patient Outcomes

    Helping to Improve Patient Outcomes

    Published April 2022

    Authorization to Disclose Information

    MVP strives to create the best experience for our Members, your patients. Collaboration between providers can make a positive impact on their overall health by helping to close communication gaps, identify potential health issues before they arise, and provide more comprehensive care. MVP encourages providers to work with their patients to sign releases of information to offer a more integrative approach to treatment. MVP Case Managers (CMs) help to coordinate care by educating Members on completing an Authorization to Disclose Information Form (PDF).


  • Provider Availability to Members

    Provider Availability to Members

    Published April 2022

    MVP Participating Providers must ensure that there is 24/7 coverage for Members. PCPs may use a back-up call service, provided that a physician is always available to back up the call service. PCPs agree that, in the case of an absence, they will arrange for patient care to be delivered by another provider and ensure the covering provider participates with MVP. If arrangements are made with a non-participating physician, it is the responsibility of the participating physician to ensure that the non-participating physician will: 

    • Accept MVP’s fee as full payment for services delivered to MVP Member patients 
    • Accept the MVP peer-review procedures 
    • Seek payment only from MVP for covered services provided to Members and at no time bill or otherwise seek compensation for covered services from MVP Members, except for the applicable co-payments 
    • Comply with MVP utilization management and quality improvement procedures 

    Note: Providers who are not contracted for Government Program lines of business are considered non-participating for Government Program plan types (Medicaid Managed Care, HARP, and Child Health Plus). When submitting the insurance claim to MVP, the covering provider should indicate “covering for Dr. ‘X’” in box 19 of the CMS-1500 claim form.


  • MVP Code of Ethics and Business Conduct Summary

    MVP Code of Ethics and Business Conduct Summary

    Published April 2022

    MVP provides this Code of Ethics and Business Conduct Summary as part of its commitment to conducting business with integrity and in accordance with all federal, state, and local laws. This summary provides MVP’s network Providers, vendors, and delegated entities (Contractors) with a formal statement of MVP’s commitment to the standards and rules of ethical business conduct. All MVP Contractors are expected to comply with the standards as highlighted below. View MVP’s Corporate Code of Ethics and Business Conduct (PDF).

    Protecting Confidential and Proprietary Information

    It is of paramount importance that MVP’s Member and proprietary information be always protected. Access to proprietary and Member information should only be granted on a need-to-know basis and great care should be taken to prevent unauthorized uses and disclosures. MVP’s Contractors are contractually obligated to protect Member and proprietary information.

    Complying with the Anti-Kickback Statute

    As a Government Programs Contractor, MVP is subject to the federal anti-kickback laws. The anti-kickback laws prohibit MVP, its employees, and Contractors from offering or paying remuneration in exchange for the referral of Government Programs business.

    Reviewing the Federal and State Exclusion, Preclusion, and Identification Databases

    MVP and its Government Programs Contractors are required to review the applicable federal and/or state exclusion, preclusion, and identification databases. These database reviews must be conducted to determine whether potential and current employees, Contractors, and vendors are excluded or precluded from participation in federal and state sponsored health care programs. The federal and state databases are maintained by the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the General Services Administration (GSA), the New York State Office of Medicaid Inspector General (OMIG), the Social Security Administration Death Master File (SSADMF) and the National Plan and Provider Enumeration System (NPPES). 

    Prohibiting the Acceptance of Gifts

    MVP prohibits employees from accepting or soliciting gifts of any kind from MVP’s current or prospective vendors, suppliers, providers, or customers that are designed to influence business decisions.

    Detecting and Preventing Fraud, Waste, and Abuse (FWA)

    MVP has policies and processes in place to detect and prevent fraud, waste, and abuse (FWA). These policies outline MVP’s compliance with the False Claims Act and other applicable FWA laws and regulations. These laws and regulations prohibit MVP and its Contractors from knowingly presenting or causing to present a false claim or record to the federal government, the State Medicaid program, or an agent of these entities for payment or approval. View MVP’s policy for Detecting and Preventing Fraud, Waste and Abuse (PDF). MVP’s Special Investigations Unit (SIU) is instrumental in managing the program to detect, correct, and prevent FWA committed by providers, Members, subcontractors, vendors, and employees. The SIU maintains a toll-free, 24-hour hotline, 1-877-835-5687, where suspected fraud, waste, and abuse issues can be reported directly by internal and external sources.

    Providing Compliance Training, Fraud, Waste,and Abuse (FWA) Training and HIPAA Training 

    To prevent and detect FWA, all MVP’s Contractors that support its Medicare products and who are first tier, downstream, or related entities (FDRs) are required to provide general compliance training and FWA training to their employees, subcontractors, and downstream entities upon hire, annually, and as changes are implemented. The Centers for Medicare and Medicaid Services (CMS) provides a Medicare Parts C and D FWA and general compliance training program. This online program is available through the CMS Medicare Learning Network. Entities who have met the FWA certification requirements through enrollment into Parts A or B of the Medicare Program or through accreditation as a supplier of DMEPOS are deemed to have met the FWA training requirement. However, these entities must provide general compliance training. MVP’s Contractors that support its Medicaid products are also required to provide general compliance and FWA training to their employees, subcontractors, and downstream entities upon hire, annually and as changes are implemented. In addition, Contractors who handle MVP Protected Health Information are required to provide HIPAA Privacy, Security, and Breach Prevention trainings to their employees.

    Reporting Suspected Violations

    MVP provides an Ethics and Integrity Hotline for reporting suspected violations of the Code or of its legal requirements. The Ethics and Integrity Hotline – 1-888-357-2687 – is available for employees, vendors, and Contractors to report suspected violations anonymously. Reports of suspected fraud, waste, and abuse may also be reported anonymously by contacting the Ethics and Integrity Hotline. EthicsPoint manages MVP’s confidential reporting system and receives calls made to the Hotline. EthicsPoint triages reports in a secure manner to MVP’s Compliance Office. The Compliance Office promptly and thoroughly investigates all allegations of violations. All MVP Contractors are required to report actual or suspected non-compliance and FWA that impacts MVP using the hotlines referenced above. Contractors are protected from intimidation and retaliation for good faith participation in MVP’s Compliance Program.


  • Provider Policies and Payment Policies Effective April 1, 2022

    Provider Policies and Payment Policies Effective April 1, 2022

    Published April 2022

    MVP Provider Policies and Payment Policies includes revisions on operational procedures, plan type offerings, and clinical programs. The policies are designed to serve as a reference tool for Providers and facilities. The following policies have been updated, with an effective date of April 1, 2022, and are posted at mvphealthcare.com/policies.

    Provider Policy Updates Effective April 1, 2022

    • Behavioral Health Policy
    • Claims
    • Contacting MVP
    • Provider Responsibilities

    Payment Policy Updates Effective April 1, 2022

    • After-Hours
    • Allergy Testing and Serum Preparation Claims
    • Audiology Services
    • Arthroscopic, Endoscopic, and other Non-Gastrointestinal Scope Procedures
    • Consistency of Denials
    • Default Pricing
    • Home Infusion
    • Interpreter Services
    • Infusion Policy
    • JW Modifier
    • Laboratory Services
    • Mental Health and Substance Use Disorder
    • Mid-Level Payment Policy
    • Multiple Surgery – VT Only
    • NDC Policy
    • Preventive Payment Policy
    • Radiology
    • Transitional Care Management
    • Viscosupplementation of the Knee: Non-Coverage for Medicaid Manage Care (MMC) Plans (new policy)


  • Improving Behavioral Health Follow-Up Care

    Improving Behavioral Health Follow-Up Care

    Published April 2022

    Follow-up Care After Emergency Department Visits

    According to the US National Institutes of Health, 50% of all hospital admissions are a direct result of Emergency Department (ED) visits. Timely followup care with the patient after an ED visit may be the key to reducing return ED visits as well as improving overall population health outcomes.

    Behavioral Health ED Visits

    For ED visits due to a Behavioral Health event, such as mental illness, alcohol dependence, or substance use disorders, studies have demonstrated the benefits of timely follow-up care such as decreased suicidal ideation, reduced ED readmissions, and improved medication adherence1. Furthermore, the American Medical Association has found that follow-up care for people with Behavioral Health conditions not only lead to fewer repeat ED visits, but also improved physical and mental function, and increased compliance with follow-up instructions.

    Implementing Best Practices for Follow-Up Care

    Reach out to your patients to schedule a follow-up appointment as soon as you are notified of their ED visit. Utilize your health information exchange (HIE) to gain more information on ED discharges or collaborate with hospital ED’s to obtain data exchange reports on your patients seen in the ED for better care coordination. If available, offer your patients options for telemedicine services for follow-up care, including:

    • Telephone visits
    • Telehealth visits
    • Online Assessment (e-visits or virtual check-ins)

    Providers can improve the transition of care by connecting Members with appropriate Behavioral Health care providers in their area or working with Members to sign information sharing agreements that facilitate integrated health care between providers. For more information on follow-up care after ED visits for Behavioral Health events, view MVP’s HEDIS Provider Reference Guides.

    MVP Behavioral Health Care Program

    MVP’s Behavioral Health care program connects Members to licensed Behavioral Health clinicians who are available for support calls, to help improve their daily quality of life, and to help them better understand their Behavioral Health condition. If you are treating MVP Members who may benefit from this program, refer them to MVP Case Management at 1-866-942-7966, Monday–Friday 8:30 am–5 pm.

    1Source: Psychiatry Online: ps.psychiatryonline.org/ doi/10.1176/appi.ps.201500104


  • Provider Excellence Program

    Improving Behavioral Health Follow-Up Care

    Published April 2022

    The MVP Provider Excellence Program provides our physicians and MVP Members relevant quality and cost data to help them make informed health care decisions.

    Why is it important?

    • Creates awareness of high-performing Providers within the MVP network
    • Provides additional support to strategic Provider groups
    • In the future, the results may inform MVP products and program benefits

    What is the value to MVP Members?

    • Encourages Members to consider using a high value Provider
    • Encourages MVP Members to consider all relevant factors when choosing a Provider and to speak with their Primary Care Physician (PCP) when selecting a specialist

    Currently, MVP publicly reports the top 15% of Provider groups for Family Medicine and Internal Medicine specialties that are in-network and contracted in New York State, only. MVP evaluates quality and cost efficiency information using a methodology that is consistent with national standards and incorporates feedback from health care professionals in our network.

    To learn more, visit mvphealthcare.com/providerexcellenceprogram. To request the full methodology, email ProviderExcellence@mvphealthcare.com.


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