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.

• Provider Resource Manual and Payment Policies

  View the Provider Resource Manual and Payment Policies.

  
  

• EDI Information and Guides

  MVP’s Payor ID is 14165

  • Billing Edits Effective May 21, 2015 (PDF)
  • EDI Frequently Ask Questions (PDF)
  • MVP Health Care’s Preferred Clearinghouse List (PDF)
  • Electronic Funds Transfer and Remittance Advice (PDF)

  Online Claim Submissions

  Providers may create and submit medical 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.

  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 835/99/277CA files.

  EDI Forms

  • Online EDI Enrollment
  • EDI Enrollment Form 835/ERA (PDF)

  EDI Guides

  • Claims Electronic Data Instruction Guide (PDF)
  • 5010 Secondary Payer and COB Rules (PDF)
  • Transaction Standard Companion Guide – 837P (PDF)
  • Transaction Standard Companion Guide – 837I (PDF)
  • Transaction Standard Companion Guide—270/271 & 276/277 (PDF)
  • Transaction Standard Companion Guide—835 (PDF)
  • Transaction Standard Companion Guide- 837D (PDF)

  EDI Routine Maintenance Schedule

  • Upcoming Planned Downtime (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

  • American Academy of Professional Coders (AAPC)
  • American Health Information Management Association (AHIMA)
  • Clinical Documentation ICD-10 (PDF)
  • Clinical Documentation Physician Tips (PDF)
  • HCC Training for Providers (PDF)
  • Medicare Learning Network

  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

  • Medical Coding and Training Resources
  • Taxonomy Reference Site
  • Vermont Health Care Price and Quality CPT Codes (PDF)
  • Medical Records Requirements (PDF)

  Provider Education

  • Diagnosis Coding Principles (PDF)
  • Commandments of Coding (PDF)
  • Improving Clinical Documentation (PDF)

  Disease Specific Chapters

  1. Certain Infectious and Parasitic Diseases (PDF)
  2. Neoplasms (PDF)
  3. Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (PDF)
  4. Endocrine, Nutritional and Metabolic Diseases (PDF)
  5. Mental, Behavior and Neurodevelopment Disorders (PDF)
  6. Diseases of the Nervous System (PDF)
  7. Diseases of the Eye and Adnexa (PDF)
  8. Diseases of the Ear and Mastoid Process (PDF)
  9. Diseases of the Circulatory System (PDF)
  10. Diseases of the Respiratory System (PDF)
  11. Diseases of the Digestive System (PDF)
  12. Diseases of the Skin and Subcutaneous Tissue (PDF)
  13. Diseases of the Musculoskeletal System and Connective Tissue (PDF)
  14. Diseases of the Genitourinary System (PDF)
  15. Pregnancy, Childbirth and the Puerperium (PDF)
  16. Certain Conditions Originating in the Perinatal Period (PDF)
  17. Congenital Malformations, Deformations and Chromosomal Abnormalities (PDF)
  18. Symptoms, Signs and Abnormal Clinical and Laboratory Findings (PDF)
  19. Injury, Poisoning and Certain Other Consequences of External Causes (PDF)
  20. External Causes of Morbidity (PDF)
  21. Factors Influencing Health Status and Contact with Health Services (PDF)

  
  

• HEDIS 2019 Reference Guides

  • HEDIS 2019 Coding Reference Guide for OBGYN (PDF)
  • HEDIS 2019 Coding Reference Guide for Primary Care (PDF)
  • HEDIS 2019 Coding Reference Guide for Behavioral Health (PDF)

  
  

• HEDIS 2019 Tip Sheets

  Child and Adolescent Care

  • Adolescent Well-Care (AWC) Weight Assessment and Counseling for Children and Adolescents (WCC) Adolescent Preventive Care (ADL) (PDF)
  • Childhood Immunization Status (CIS) and Lead Screening in Children (LSC) (PDF)
  • Follow-Up Care for Children Prescribed ADHD Medication for Attention Deficit Disorder (ADD) (PDF)
  • Immunizations for Adolescents (IMA) (PDF)
  • Metabolic Monitoring for Child and Adolescents on Antipsychotics (APM) (PDF)
  • Medication Management for People with Asthma (MMA) and Asthma Medication Ratio (AMR) (PDF)
  • Use of Multiple Concurrent Antipsychotics in children and Adolescents (APC) (PDF)
  • Well-Child Visits in the First 15 Months of Life (W15) (PDF)
  • Well-Child Visits in Years Three, Four, Five and Six of Life (W34) and Weight Assessment and Counseling for Children and Adolescents (WCC) (PDF)

  Adult Medical Conditions & Preventive Care

  • Colorectal Cancer Screening (COL) (PDF)
  • Controlling High Blood Pressure (CBP) (PDF)
  • Use of Imaging Studies for Low Back Pain (LBP) (PDF)
  • Medication Management for People with Asthma (MMA) and Asthma Medication Ratio (AMR) (PDF)

  Diabetes Care

  • Comprehensive Diabetes Care (CDC): Overview (PDF)
  • Comprehensive Diabetes Care (CDC): Blood Pressure Control (PDF)
  • Comprehensive Diabetes Care (CDC): HbA1c (PDF)
  • Comprehensive Diabetes Care (CDC): Nephropathy (PDF)
  • Comprehensive Diabetes Care (CDC): Retinal Exam (PDF)
  • Comprehensive Diabetes Care (CDC): Retinal Exam Using Funduscopic Photography (PDF)
  • Screening for Prediabetes (PDF)

  Women’s Care

  • Breast Cancer Screening (BCS) (PDF)
  • Cervical Cancer Screening (CCS) (PDF)
  • Chlamydia Screening in Women (CHL) (PDF)

  Behavioral Health Care

  • Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA) (PDF)
  • Antidepressant Medication Management (AMM) (PDF)
  • Diabetes Monitoring for People with Diabetes and Schizophrenia (SMD) (PDF)
  • Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are using Antipsychotic Medications (SSD) (PDF)
  • Follow-up after Hospitalization for Mental Illness (FUH) (PDF)
  • Follow-Up Care for Children Prescribed ADHD Medication for Attention Deficit Disorder (ADD) (PDF)
  • Metabolic Monitoring for Child and Adolescents on Antipsychotics (APM) (PDF)
  • Use of Multiple Concurrent Antipsychotics in children and Adolescents (APC) (PDF)

  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)

  
  

• 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

  • 2016 ICD-10-CM Changes (PDF)
  • ICD-10 Issues: Questions and Answers (PDF)
  • ICD-10 Specialties Training Presentations

  
  

• Opioid/Pain Management Resources

  • Non-Opioid Pain Management Options Provider Guide (PDF)

  
  

• Children and Family Treatment and Support Services

  Starting 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.

  Starting July 1, 2019, MVP will cover 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. The program will be phased-in over the next 18 months, with the first three services being implemented on January 1, 2019.

  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.

  How are these services being rendered?

  Beacon Health Options has a provider network that are rendering the services listed above. Beacon is also responsible for the administration of claims. MVP will provide Care Management services.

  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. Beacon Health Options is administering CFTSS Services as well as additional Behavioral Health Services for children. For questions, call Beacon’s provider relations at 1-844-265-7595.

  
  

• 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
  • NPI Information

  
  

• Guides for Using Our Site

  • Access Your MVP Online Account (PDF)
  • Authorization Look-up (PDF)
  • Electronic Claim Adjustment Request Form (CARF) (PDF)
  • Provider Portal Registration Guide (PDF)
  • Learn More About the New Menu Options (PDF)
  • Presentation: Setting Notification Preferences
  • Summary of Provider Portal Enhancements (PDF)
  • Upcoming Planned Downtime (PDF)

  
  

• Utilization Management

  • Assistant Surgery List (Effective July, 2019) (PDF)
  • Durable Medical Equipment Prior Authorization List (Effective July 1, 2019) (PDF)
  • In-Office Procedure List (Effective July 1, 2019) (PDF)
  • MVP Inpatient Surgical list (Effective January 1, 2018) (PDF)
  • DME Non-Covered Items (PDF)