The information on this web page is intended for practitioners and facilities in the MVP service area. This area includes most of New York state and Vermont. Please refer to the MVP Service Area maps to determine if you are within the MVP service area. Practitioners outside of the area may provide services to MVP members via the Cigna national network. If you are a provider outside of the MVP service area and are interested in joining the Cigna network, learn how to join the CIGNA Network.

Credentialing FAQs

  • Who needs to be credentialed?

    Physicians (see exceptions under Practitioner Registration), oral surgeons, podiatrists, optometrists, audiologists, physical therapists, occupational therapists, speech/language pathologists, certified nurse midwives, certified diabetes educators, registered dieticians/nutritionists and behavioral health practitioners. There are additional credentialing requirements, specific by state, for naturopaths and athletic trainers (Vermont only),  Nurse Practitioners (NPs) Independent in specialty areas approved by New York State Public Health Law and NPs in a physician practice with a PCP specialty who wish to practice as a PCP (New York only), and advanced practice registered nurses (Vermont). In addition, certain facility types must also undergo credentialing. Please refer to the “Facility Credentialing” section of this page for details.

    Important: Chiropractors, acupuncturists and massage therapists are contracted and credentialed through an agreement with Landmark Health Care. Please go to Landmark Health Care for additional information.

    All behavioral health practitioners and behavioral health facilities located outside of Vermont are contracted and credentialed through our partnership with Beacon Health Options. Please visit Beacon Health Options for additional information.

    Optometrists that provide vision services in Dutchess, Orange, Rockland, Sullivan, Ulster, and Westchester Counties for Medicaid, Child Health Plus, and the Essential Plans are contracted and credentialed through an agreement with  Superior Vision. Please go to Superior Vision for additional information.

    Please note that contracting and credentialing of health care practitioners may be limited by geographic need.


  • How do I apply?

    All practitioners who require credentialing must complete the online Coalition for Affordable Quality Health Care (CAQH) Universal Credentialing Application®. To get started please do the following:

    • Complete or update your CAQH online application. Be sure that you have listed MVP as an authorized plan. For assistance with completion of the CAQH application please contact the CAQH Help Desk at 1-888-599-1771 or email your question to caqh.updhelp@acsqs.com.

    Provider Participation Guide: Initiating and retaining participation with MVP.


  • When will the credentialing process begin?

    The credentialing process will not be started until MVP has been given access to a complete CAQH application (including current documentation of adequate malpractice insurance, current licensure etc.) and the applicant has returned a signed contract (if applicable). Once the application has been determined to be complete, the Credentialing Staff will begin primary source verification of education, licensure, training etc. as per state and federal regulations.


  • When does the credentialing process end?

    The process is completed when all elements required by state and federal law have been verified and all required queries are complete. At that time, the application and verification will be presented to the MVP Credentials Committee for review and decision regarding participation.

    Important: Credentialing applicants are not authorized to provide services to MVP members until they have been reviewed and approved for participation by the MVP Credentials Committee. Practitioner effective dates will not be made retroactive prior to the Credentials Committee approval date.


Credentialing Criteria

All practitioners are required to meet the minimum criteria for their specialty.  Criteria are available by contacting the MVP Credentialing Department at 888-363-9485. View General Credentialing Criteria (PDF).

New practice offices/locations for physicians or nurse practitioners (NY) providing primary care services (PCPs) and OB/GYNs will be required to undergo a practice site inspection, including a review of medical record keeping practices.

  • 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.


  • Practitioner Rights

    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, and hospitals. Recommendations, letters of reference and other peer review protected information are not subject to this disclosure. (Note: Disclosure of NPDB documentation can only be released directly to the Practitioner.)
    • 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 the 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 Management staff will notify the practitioner, in writing, of the discrepancy.
    • The right to be informed of their credentialing or recredentialing application status. MVP Health Care, 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 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:
    1. Whether s/he is credentialed; or
    2. Whether additional time is necessary to make a determination because of a failure of a third party to provide necessary documentation., 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:
    1. 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
    2. 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.


  • Practitioner Registration

    The following practitioner types do not require credentialing but must be registered with MVP: Hospitalists (Internal Medicine, Pediatric or Family Medicine), Emergency Department Physicians, Pathologists, 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. Download the Registration Form.

    Exceptions: Anesthesiologists who want to be designated as Pain Treatment specialists or Hospitalist physicians who also work outside of the inpatient setting must be credentialed.


  • Demographic Changes for Credentialed Practitioners

    All demographic changes are handled by the Professional Relations Department at 1-888-363-9485 or complete and return the Provider Change Form located in the Provider Forms section.


  • Facility Credentialing

    Facilities (organizational providers) who wish to participate with MVP Health Care should contact the Network Development Department at 1-877-736-5735 for information. The following facility types are required to be credentialed prior to participation with MVP. They are ambulatory mental health and substance abuse treatment facilities, adult day health care centers (New York only), HIV/AIDS day care centers (New York only), bariatric surgery centers, federally qualified health care centers, free-standing ambulatory surgery centers, free-standing birthing centers (New York only), free-standing dialysis centers, free-standing radiology centers, free-standing rehabilitation centers (mental rehab and physical rehab only), home health agencies, including those agencies providing home infusion services and personal care assistant services, hospice, hospitals, hyperbaric medicine treatment centers, long-term care facilities, portable/mobile X-ray suppliers, psychiatric hospitals, residential alcohol/substance abuse treatment facilities, skilled nursing facilities, transplant programs, ventricular assistance device programs, and Urgent Care Centers. View General Facility Criteria (PDF).

    Urgent Care Centers are required to submit a hospital transfer protocol to verify how they intend to ensure timely and adequate communication with the receiving hospital and PCP in the event a patient requires emergent transfer to a hospital. A copy of the protocol should be submitted with the completed Hospital Transfer Protocol Fax Cover Sheet (PDF).


MVP Credentialing Contact Information

To contact a member of the MVP Health Care Credentialing Department, please call 1-888-363-9485.