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 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.
Access and Availability Standards
EDI Information and Guides
Coding, Medical Record Documentation and Education
HEDIS Provider Reference Guides
HEDIS 2019 Coding Reference Guides
ICD-10 Updates and FAQs
Opioid/Pain Management Resources
Medicaid Management Information System (MMIS)
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)
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.
- MVP Providers who are not eligible for Article 29-1 licensure should complete the MVP Medicaid Children’s Foster Care Training for Providers
- 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.
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)
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.
- 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.
Guides to MVP Benefits & Plans
Understanding MVP’s National Alliance with Cigna HealthCare
Learn about MVP Policies
Additional Education Resources
Guides for Using Our Site
Support Services for Children
Find national organizations and New York State agencies that can help children and families during difficult times.
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.
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:
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:
- Login to their Provider Online Account or request access here.
- Speak with a representative by calling the MVP Provider Services at
- 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
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)
HEDIS Measures and Gaps in Care Resources