Credentialing and Registration
All Providers must complete the credentialing or registration process to participate in the MVP Health Care network. Be sure to review the MVP Service Area maps to view the regions we serve, and to determine if you are within our footprint. We look forward to partnering with you!
To get started:
- Complete or update your CAQH online application
For assistance on completing or updating the CAQH online application, contact the CAQH Help Desk at 1-888-599-1771 or email your question to email@example.com.
- Review the MVP Provider Participation Guide
The Provider Participation Guide contains complete information and instructions on initiating participation with MVP.
- Complete the Provider Application Request
This Application Request should be completed by any Provider requesting to participate with MVP. To properly use the Provider Application Request Form, please right-click the link and select “Save link as” to save the file to your device. Then the form can be populated in Acrobat Reader. This should NOT be filled in from your browser.
All practitioners are required to meet the minimum criteria for their specialty. Criteria are available by email at firstname.lastname@example.org. New practice offices/locations for physicians or nurse practitioners (NY) providing primary care services (PCPs) and OB/GYNs are required to undergo a practice site inspection, including a review of medical record keeping practices.
Below you will find additional information related to the credentialing and registration process as well as guidance from NYS. Included please find HIV/AIDS Specialty Designation, Practitioner Rights, Provisional Credentialing of NYS Physicians, and Practitioner Registration.
HIV/AIDS Specialty Designation
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.
All practitioners have the following rights:
- The right to review information received in support of their credentialing application.
- Applicants have the right to review the information obtained from any outside primary source that is presented to the Credentials Committee in support of their credentialing and/or recredentialing application. For example, malpractice insurance carriers, state licensing boards. However, MVP must have written consent from 3rd party sources such as verification of hospital privileges or previous employment before it can release that information to the applicant. Recommendations, letters of reference and other peer review protected information are not subject to this disclosure. (Note: MVP cannot disclose NPDB documentation. The Practitioner must request a copy of their report directly from the NPDB.)
- Upon receipt of an applicant’s written, signed and dated request, MVP will release under confidential cover to the applicant by Delivery Confirmed or Certified Mail, Return Receipt Requested all the allowed information that is presented to the Credentials Committee in support of their credentialing/recredentialing application.
- The right to correct erroneous information submitted during the credentialing/recredentialing process. Should the Credentialing Staff receive information that differs substantially from the information provided by the practitioner, a member of the Credentialing Department staff will notify the practitioner, in writing, of the discrepancy.
- The right to be informed of their credentialing or recredentialing application status. MVP, upon applicant’s direct verbal or written request, will notify him/her of the status of their application.
Provisional Credentialing of NYS Physicians
State of New York
MVP shall complete a review of the health care professional’s application to participate in the in-network portion of MVP’s network and shall, within 60 days of receiving a completed application* and all required documentation to participate in the MVP’s network, notify the health care professional as to:
- Whether he/she is credentialed; or
- Whether additional time is necessary to decide because of a failure of a third party to provide necessary documentation, or if additional information is necessary, the notice to the health care professional must identify all additional information needed by the plan to make its determination. In such instance where additional time is required because of a lack of necessary documentation, the plan shall make every effort to obtain such information as soon as possible and shall make a final determination within 21 days of receiving the necessary documentation.
Note: For applicants that are (1) newly licensed health care professionals or (2) a health care professional who has recently relocated to New York from another state and has not previously practiced in New York; and who are joining a participating group in which all Members of the group currently participate with MVP, the applicant shall be eligible for provisional credentialing as of the 61st day of the application if:
- The applicant has submitted a Completed Application and any requested supporting documentation; and
- The applicant provided written notification to the MVP Director of Credentialing, including a statement that in the event the applicant is denied, the applicant or the applicant’s group practice:
- Shall refund any payments made for in network services provided during the period of provisional credentialing that exceed out-of-network benefits under the insured’s contract with MVP; and
- Shall not pursue reimbursement from the insured, except to collect the copayment or coinsurance that otherwise would have been payable had the insured received services from a participating MVP practitioner.
Completed Application* for Credential and Recredential includes: a complete and accurate CAQH application, re-attested to within the last 90 days, plus all supporting documentation including, but not limited to malpractice insurance certificate, continuity of care arrangements that meet MVP criteria for specialty, explanation of any affirmative responses including malpractice suits, an explanation of any work history gaps of over six months, a re-entry plan for all gaps over one year, and MVP’s receipt of all verifications from third party sources. The practitioner is obliged to provide MVP with information sufficiently detailed to render an opinion regarding any affirmative response.
The following practitioner types do not require credentialing but must be registered with MVP: Hospitalists (Internal Medicine, Pediatric or Family Medicine), Emergency Department Physicians, Hospital-based Pathologists, Hospital-based Anesthesiologists, Neonatologists, Certified Registered Nurse Anesthetists, Nurse Practitioners working in a physician practice who do not act in the capacity of a primary care provider, and Physicians Assistants. Fill out the Provider Application Request.
Exceptions: Anesthesiologists who want to be designated as Pain Treatment Specialists, as well as Hospitalist physicians, Emergency Department physicians, Anesthesiologists, and Pathologists who work outside of the inpatient setting must be credentialed.
Small Group Plans (1-100 employees)
Medicaid & Child Health Plus Plans
Medicare Advantage Plans
These products will be administered according to their respective MVP Certificates/Contracts of Coverage. For a complete listing of all Plan Type information, refer to the MVP Provider Resource Manual and select MVP Plan Type Information.
MVP National Networks
Practitioners outside of the area may provide medical services to MVP Members via the Cigna national network. Providers outside of the MVP service area interested in joining the Cigna network may learn how to learn how to join the Cigna Network.
Behavioral Health providers outside of the area may provide services to MVP Members via the First Health / MagnaCare national networks. Learn how to join the First Health network. Learn how to join the MagnaCare network.