Reference Library

From details on how to use our provider portal, to guides to MVP policies, MVP’s reference library offers quick access to a variety of helpful resources.

MVP Provider Policies and Payment Policies
View the MVP Provider Policies and Payment Policies.
Provider FastFax
View all Provider FastFax.
MVP Provider Education Resources
MVP Health Care has developed many educational resources to help keep our providers informed and ensure successful partnerships.

View MVP Provider Education
Access and Availability Standards
- New York Behavioral Health Variation to Access Standards (PDF)
- New York Foster Care Access Standards (PDF)
- New York Medical Health Access Standards (PDF)
- Vermont Health Access Standards (PDF)
EDI Information and Guides
MVP’s Payor ID is 14165
Online Claim Submissions

Providers may create and submit medical and behavioral health claims online to MVP by accessing mvphealthcare.transshuttle.axiom-systems.com. This website is hosted and powered by AXIOM and the services available therein are offered by AXIOM to providers on behalf of MVP Health Care. AXIOM may require that users agree to AXIOM’s site requirements and certain terms of use before accessing AXIOM’s services. Please note an NPI is required in order to setup an account.
- MVP Trans Shuttle Sign Up Guide (PDF)
EDI Options and Enrollment Preferences

Providers who prefer a paper check with an electronic remittance should complete the Online EDI Enrollment form.

Providers who prefer EFT\ERA should contact PaySpan directly to set up your clearinghouse for permission to retrieve electronic remittance advice. If you choose this option, please do not complete the Online EDI Enrollment form. If an MVP EDI Enrollment Form is received and the provider/facility is set up with PaySpan, the form will be rejected and returned. Read our helpful Electronic Funds Transfer (EFT) and Remittance Advice for helpful information regarding registering for EFT\ERA with PaySpan.

Have a Legacy Transaction Account?

Log in here if you have an existing account to submit 837 files or retrieve 835/999/277CA files. MVP is not currently accepting new applications for internet claim submissions through our website or the retrieval of 835/999/277CA files.

EDI Forms
- Online EDI Enrollment
- EDI Enrollment Form 835/ERA (PDF)
EDI Guides
EDI Routine Maintenance Schedule
- 2022 Routine Scheduled Maintenance (PDF)
Questions? Contact our EDI Service Department

Call 1-877-461-4911 or email MVP EDIServices@mvphealthcare.com
Coding, Medical Record Documentation and Education
Medical Coding and Training Resources
ICD-10-CM 2021 Coding Guidelines
If you feel your office would benefit from additional ICD-10-CM coding training, please contact our Medicare Risk Adjustment Team Trainers.

West/Central Regions

MaryEllen Reardon at (585) 279-8583 or mreardon@mvphealthcare.com

East Regions

Shannon Chase at (518) 386-7502 or schase@mvphealthcare.com

Additional Resources
2021 HEDIS Provider Reference Guides
Child and Adolescent Care
Adult Medical Conditions & Preventive Care
Diabetes Care
Women’s Preventive Care
- Breast Cancer Screening (BCS) (PDF)
- Cervical Cancer Screening (CCS) (PDF)
- Chlamydia Screening in Women (CHL) (PDF)
Behavioral Health Care
General References for HEDIS Compliance
- Scheduling Guidelines (PDF)
- HEDIS FAQs (PDF)
- How to Close Gaps (PDF)
- Closing Gaps in Care (PDF)
- No Show Strategies (PDF)
HEDIS 2019 Coding Reference Guides
ICD-10 Updates and FAQs
The U.S. Department of Health and Human Services established a new set of standards for the electronic exchange of HIPAA transactions between providers and payers. Included in this new set of standards is support for ICD-10 (International Classification of Diseases, 10th Revision) codes, which provide a better definition of diagnoses and procedures. MVP will provide current news on ICD-10 information to help you move to ICD-10, and information on MVP’s implementation of ICD-10. Please check often for updates.

ICD-10 Resources
Opioid/Pain Management Resources
- Non-Opioid Pain Management Options Provider Guide (PDF)
Medicaid Management Information System (MMIS)
- Medicaid Management Information System (MMIS) Frequently Asked Questions (PDF)
New York State Medicaid Programs for Children
Transition of Children in Voluntary Foster Care Into Medicaid Managed Care

Effective July 1, 2021, children placed in voluntary foster care will transition into Medicaid Managed Care. Voluntary Foster Care Agencies (VFCAs) who obtain an Article 29-I licensure will be able to provide core limited health-related services (CLHRS) to foster care children, and other limited health related services (OLHRS) as determined by NYS. As part of this transition, MVP has a dedicated foster care liaison who will act as a single point of contact between MVP and the VFCAs, and other health care partners.

Core limited health-related services include
- Skill building
- Nursing supports and medication management
- Medicaid treatment planning and discharge planning
- Clinical consultation and supervision
- Managed Care Liaison/ administration
Limited health-related services may include
- Screening, diagnosis, and treatment related to physical/developmental/Behavioral Health
- Children and family treatment and support services (when designated a children’s Provider)
- Children’s home and community-based services (when designated a children’s Provider)
Training requirements

New York State requires Providers to take training related to VFCA. The training is self-directed; however, MVP PR representatives will be happy to assist or answer any questions. Providers are required to verify they have completed one of the trainings.

Training Options
1. MVP Providers who are not eligible for Article 29-1 licensure should complete the MVP Medicaid Children’s Foster Care Training for Providers
1. MVP Providers who are requesting the new Article 29-I licensure should complete the MVP Medicaid Children’s Foster Care Training for Foster Care Agencies
Access the trainings at mvphealthcare.com/VFCAeducation and select the appropriate training document to meet your specific requirement.

Children and Family Treatment and Support Services (CFTSS)

As of January 1, 2020 MVP covers more Children and Family Treatment and Support Services (CFTSS). These services help children and their families improve their health, well-being, and quality of life.

CFTSS are for children under age 21 with behavioral health needs. These services may be provided at home or in the community. As of January 1, 2020, MVP Medicaid Managed Care members under age 21 will be able to access the following services:

Youth Peer Support and Training

This benefit is provided by a credentialed Youth Peer Advocate, or Certified Recovery Peer Advocate with a youth focus who has similar experiences. This benefit provides support and assistance with:
- Developing skills to manage health challenges and be independent,
- Feeling empowered to make decisions,
- Making connections to natural supports and resources, and
- Transitioning to the adult health system when the time is right.
Crisis Intervention

This benefit provides professional help at home or in the community when a child or youth is distressed and can’t be helped by family, friends, and other supports. This benefit includes support and help with using crisis plans to de-escalate the crisis to prevent or reduce future crises.

MVP may already cover these services for certain eligible children under age 21. If a member is currently getting these services, their care will not change.

As of October 1, 2019, Home- and Community-Based Services (HCBS) for Children will only be available to select Medicaid Managed Care (MMC) members.

Who is eligible for these services?

Medicaid members under the age of 21, that have behavioral health needs and/or medically complex conditions are eligible to receive services in their own home or community. These services were previously covered under Medicaid fee-for-service for children under Medicaid’s waiver programs.

How will services be rendered?

MVP will collaborate with Health Home Care Managers, Children Youth Evaluation Services (CYES), service providers, and caregivers to help members to manage chronic health conditions and improve health outcomes.

MVP will receive plans of care prior to 10/1/2019 for review. Children in treatment as of 10/1/2019 may continue with their current HCBS care providers for continuity of care. MVP will continue to authorize the most recent plan of care in effect when services are transitioned to MMC. Continuity of care will be in place for the first 24 months of the transition.

How do I learn more about these and other services?

MVP has produced training documents for HCBS, Children and Family Treatment and Support Services (CFTSS), and Children’s Transition information that may be helpful to providers. These are available at mvphealthcare.com/providers/education.

As of July 1, 2019, MVP covers more behavioral health services for children and youth.

MVP Medicaid Managed Care members under age 21 will be able to access the following services:

Office of Alcoholism and Substance Abuse Services (OASAS), including:
- Outpatient Clinic (Hospital Based)
- Rehabilitation Programs (Hospital Based)
- Opioid Treatment Program Services (Hospital Based)
- Chemical Dependence Inpatient Rehabilitative Services
Injections for Behavioral Health Related Conditions

Children and Family Treatment and Support Services (CFTSS), including:
- Psychosocial Rehabilitation (PSR)
- Community Psychiatric Supports and Treatment (CPST)
- Family Peer Support Services
- Other Licensed Practitioner (OLP)
Office of Mental Health (OMH) Outpatient Services and Designated Serious Emotional Disturbance (SED) Clinic Services
Assertive Community Treatment (ACT)
Continuing Day Treatment
Personalized Recovery Oriented Services (PROS)
Partial Hospitalization
Psychiatric Services
Psychological Services
Comprehensive Psychiatric Emergency Program (CPEP)       including Extended Observation
Inpatient Psychiatric Services 

Who is covered for these services?

MVP will cover these services for all eligible children and youth under age 21, including those:
- With Supplemental Security Income (SSI)
- Who have Federal Social Security Disability Insurance (SSDI) status, or
- Who have been determined certified disabled by a New York Medical disability review.
As of January 1, 2019, children with non-Supplemental Security Income (SSI) Medicaid Managed Care (MMC) will have additional coverage so they can take advantage of additional behavioral health treatment and support services for their families.

These services place strong emphasis on early identification and access to treatment. The intention is to prevent the onset or progression of behavioral health conditions and a need for long-term or more expensive services. Some of these services will allow the child to be treated in the home and other natural, community-based settings where children/youth and their families live.

What are the first three services?

The services that will be effective January 1 include:
- Other Licensed Practitioner (OLP) – lets children get individual, group, or family therapy where they are most comfortable.
- Psychosocial Rehabilitation (PSR) – helps children relearn skills to help them in the community.
- Community Psychiatric Supports and Treatment (CPST) – helps children stay in their home and communicate better with family, friends, and others.
Additional Resources
- Information on Transition Age Youth Provider Support is available on the New York State Office of Mental Health Services website at: omh.ny.gov
- Additional information on how Providers can deliver care to children and families who experience mild-to-moderate mental health concerns can be found at projectteachny.org.
MVP Health Care is administering HCBS Services. For questions, contact MVP Provider Services at 1-800-684-9286.
Health Home
- Health Home Upward Enrollment Referral Form (PDF)
Guides to MVP Benefits & Plans
- Harmonious Health Care Plan FAQs (PDF)
- NY Marketplace Quick Reference Guide (PDF)
- VT Marketplace Quick Reference Guide (PDF)
Understanding MVP’s National Alliance with Cigna HealthCare
- CIGNA Reference Guide (PDF)
Learn about MVP Policies
- Code of Ethics and Business Conduct Summary (PDF)
- Corporate Code of Ethics and Business Conduct (PDF)
- Detecting and Preventing Fraud, Waste and Abuse (PDF)
- Independent Dispute Resolution Process for Emergency and Surprise Bills—Health Care Providers (PDF)
- Medical & Pharmacy Policy Updates Archive (Login required. Once you are logged in, hover over Resources, then click Medical Policies.)
- NPI Information
Additional Education Resources

OnTrackNY

OnTrackNY is an innovative treatment program for adolescents and young adults who have had unusual thoughts and behaviors, or who have started hearing or seeing things that others don’t. OnTrackNY helps people achieve their goals for school, work, and relationships.

Learn more about OnTrackNY

Project TEACH

Learn more about Project TEACH by reviewing our web session held on April 28.

Project TEACH, a program funded by the New York State Office of Mental Health, aims to strengthen and support the ability of NY’s PCPs to deliver care to children and families who experience mild-to-moderate mental health concerns, including anxiety, depression, and ADHD, in children, adolescents, and young adults up to 22 years of age. Project TEACH offers providers consultation, referrals, and training at no cost.

Learn more about Project TEACH
Read about Project TEACH
Guides for Using Our Site
Utilization Management
Support Services for Children
Find national organizations and New York State agencies that can help children and families during difficult times.

Find Support Services
Gia® from MVP
Introducing Gia, an ultimate health care connection that makes it easier for our Members to find the right care, right away – and create a closer connection with their providers. Gia gives MVP Members 24/7 access to a “digital triage” solution that’s accessible anywhere by phone, web, or mobile app. Gia expertly assesses the patients’ needs, offers instant advice, and refers them when necessary, to the right course of care. Gia is also a powerful research tool, giving your patients reliable, relevant health information – much better than a web search can.

Learn More
Vermont Gold Card Prior Authorization Pilot Program
Vermont Gold Card Prior Authorization Pilot Program

As of January 15, 2022, MVP is pleased to introduce the Vermont Gold Card Prior Authorization Pilot Program which seeks to eliminate or streamline certain prior authorization requirements. The Vermont Gold Card Prior Authorization Program is for Commercial and Exchange Members in Vermont. MVP is dedicated to working with providers to optimize administrative processes while complying with all applicable regulatory requirements. This Pilot Program is designed to test a new prior authorization process that complies with Vermont Law Act 140, Prior Authorization Reform.

Criteria for qualifying for the Vermont Gold Card Pilot Program

Submitted five or more requests over six months for the qualifying Gold Card procedures and practice has an approval rate is 95% or for Imaging and Pharmacy claims.

Pharmacy Benefit for Qualifying Providers

Qualifying Providers will no longer need to submit a prior authorization request for the following Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonists:
- Aimovig
- Ajovy
- Emgality
Imaging Benefit for Qualifying Providers

Qualifying Providers will be exempt from submitting clinical information to aid in determining medical necessity for the following CPT codes:

CPT Code Description

70551 MRI Head Without Contrast

70552 MRI Head With Contrast

70553 MRI Head With and Without Contrast

When entering one of the eligible Gold Card CPT codes, it will auto-approve and generate the AUTH ID that will be transmitted to MVP.

MVP is awarding Gold Card status at the group (Tax ID) level. Based on the criteria above, seven groups in Vermont are eligible for inclusion in this program. In the Imaging component, 45% of the groups Primary Care Providers; in the Pharmacy component, 11% are Primary Care Providers.

For questions about the Vermont Gold Card Prior Authorization Pilot Program, please contact your Professional Relations Representative.
USA Care PPO Plan
MVP® USA Care PPO® plan

USA Care PPO from MVP Health Care is a Medicare Advantage PPO plan. USA Care PPO members are not restricted to a particular provider network. Direct provider contracts with MVP are not required with USA Care. USA Care PPO members do not need referrals and are free to obtain services from any provider in the U.S. who is eligible to be paid under Original Medicare. Some services require prior authorization.

Learn more: USA Care Provider Tip Sheet (PDF)

To determine an MVP member’s eligibility, providers may:
1. Login to their Provider Online Account or request access here.
2. Speak with a representative by calling the MVP Provider Services at
  1-800-684-9286
3. Utilize the MVP IVR phone system, which has access to the same information MVP representatives have access to, but you can obtain the information without speaking with anyone. To utilize this system, call MVP Provider Services at 800-684-9286, then press 1 for provider. The system will prompt you to enter the Provider NPI and Tax ID number, then the member ID and date of birth. Finally, press 1 for eligibility.
For more information about USA Care, call MVP Provider Services at
1-800-684-9286.

Provider Claim Forms:
- CMS-1500 paper claim form (sample) (PDF)
- UB-04 paper claim form (sample) (PDF)
- File USA Care Claims Electronically (PDF)
- EDI Enrollment Form
- USA Care Medicare Part D Vaccine Billing (PDF)
- Form – Prior Authorization (prescriptions) (PDF)

CPT Code	Description
70551	MRI Head Without Contrast
70552	MRI Head With Contrast
70553	MRI Head With and Without Contrast

Online Claim Submissions

EDI Options and Enrollment Preferences

Have a Legacy Transaction Account?

EDI Forms

EDI Guides

EDI Routine Maintenance Schedule

Questions? Contact our EDI Service Department

Medical Coding and Training Resources

ICD-10-CM 2021 Coding Guidelines

West/Central Regions

East Regions

Additional Resources

ICD-10 Resources

Transition of Children in Voluntary Foster Care Into Medicaid Managed Care

Children and Family Treatment and Support Services (CFTSS)

Vermont Gold Card Prior Authorization Pilot Program

Criteria for qualifying for the Vermont Gold Card Pilot Program

Pharmacy Benefit for Qualifying Providers

Imaging Benefit for Qualifying Providers

MVP® USA Care PPO® plan