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Healthy Practices 2021 Q3

MVP Health Care Professional Relations Dept PO Box 2207 Schenectady NY 12301-2207 mvphealthcare.com / providers [email protected] Customer Care Center for Providers 1-800-684-9286 A quarterly publication for MVP Health Care ® Providers. me built around health insurance Let’s Deliver Your patients often consider you as one of

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URL: https://content.mvphealthcare.com/provider/documents/healthy-practices-2021-q3.pdf

Healthy Practices Fall 2020 Volume 16 Number 4

(2 days ago) health outcomes, increased morbidity and mortality, and increased health care costs. Improving medication adherence is a public health priority and could reduce the economic and health burdens of many diseases and chronic conditions. CMS considers medication adherence to be a critical component

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MVP Health Care

(7 days ago) Medicare in NY and VT. MVP Health Care Medicare Advantage plans provide health insurance benefits for people age 65 years and older, as well as certain people under 65 with disabilities or specific medical conditions. Some of the basic benefits can be free of charge, and other benefits have a deductible and a monthly cost.

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Providers. Quality at MVP

(2 days ago) health provider within 7 days after discharge and then again within 30 days following hospital discharge. Measure Details Follow-up visits for this measure need to be with a mental health provider. Telehealth visits, e-visits, and virtual check-ins count for

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MVP Health Care Medicare

(5 days ago) Medicare Advantage Plans and Part D Prescription Drug and Covered Drug Lists. MVP Health Care Medicare plans provide health insurance benefits for people age 65 years and older, as well as certain people under 65 with disabilities or specific medical conditions. Some of the basic benefits can be free of charge, and other benefits have a deductible and a monthly cost.

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MVP Health Care

(1 days ago) MVP Health Care continues to work with health care providers transitioning to National Provider Identifiers (NPIs) A National Provider Identifier (NPI) is a unique 10-digit identifier assigned to a health care provider for use in conducting various transactions with other health care entities. Applying for and using an NPI is mandated under the

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MVP Health Care

(4 days ago) Healthy Practices Newsletter - Fall 2019. Spring 2019. Healthy Practices Newsletter - Spring 2019. January/February 2019. Healthy Practices Newsletter- New York. Healthy Practices Newsletter- Vermont. November/December 2018. Healthy Practices Newsletter- New York.

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MVP Health Care

(5 days ago) Medicare Advantage Plans and Part D Prescription Drug and Covered Drug Lists. MVP Health Care Medicare plans provide health insurance benefits for people age 65 years and older, as well as certain people under 65 with disabilities or specific medical conditions. Some of the basic benefits can be free of charge, and other benefits have a deductible and a monthly cost.

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BH Services and Authorization Requirements 6.30

(Just Now) Health Services Corp., operating subsidiaries of MVP Health Care, Inc. Not all plans available in all states and counties. Classified as Confidential Service NY Medicaid NY Commercial* (incl. CHP†, EP††) VT Commercial Medicare Children’s Home and Community Based Services (CHCBS)

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CMS-HCC TRAINING FOR PROVIDERS

(9 days ago) CMS reviews each health plan’s claims data for the calendar year to established an overall “risk factor” for the health plan. • The “risk factor” is determined based on diagnosis coding supported by medical record documentation. CMS will validate the health plan’s risk factor through medical record chart audits.

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Provider Resource Manual (PRM): Section 6

(8 days ago) behavioral health care, as well as for resdiential treatment for behavioral health conditions, except for family counseling services, which may be capped at 20 visits per year. 3. For MVP members’ outpatient behavioral health visits to psychologists, social workers, and

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MVP Health Care Utilization Management Policy Guide

(7 days ago) MVP Health Care UM Policy Guide Prior Authorization Process and Requirements • New York/MVMA Page 4 Prior Authorization Requirements for All MVP Plan Types Effective July 1, 2017 Additional Services All fully-insured HMO, HMO-POS, EPO, PPO, Medicare Gold, and MVP Medicaid plans. Self-insured ASO and MVP/CIGNA affiliated plans vary by plan type.

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL …

(2 days ago) MVP Health Care Medical Record Standards and Guidelines Well-documented electronic or paper medical records improve communication, and promote coordination and continuity of care. In addition, detailed medical records encourage efficient and effective treatment. For these reasons, MVP established standards for record keeping in

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MENTAL HEALTH CODING SCENARIOS

(Just Now) MENTAL HEALTH CODING SCENARIOS 1. Joe, a 43-year-old male, is currently receiving treatment for alcohol dependence. As a result of Joe’s drinking he is …

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL

(2 days ago) personal health assessment and other tools and services that promote wellness, healthy behaviors and lifestyles, including a Health Risk Screening Form that members may bring to an office visit. Members can earn rewards for getting health screenings and having …

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CEREBROVASCULAR DISEASE SEQUELA

(5 days ago) • Codes from category I69 may be assigned on a health care record with codes from I60-I67, if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease. Codes from category I69 and Personal history of transient ischemia attack (TIA) and cerebral infarction (Z86.73) •

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL

(4 days ago) Group Health Plan FECA Blk Lung Other Place an “X” in the appropriate box for the type of health insurance applicable to this claim. If the “other” box contains an “X” complete field 1a with the primary coverage identification number. If secondary coverage, refer …

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MVP Health Care

(5 days ago) Capital and Southern Tier Medicare Advantage Plans. MVP Health Care Medicare plans provide health insurance benefits for people age 65 years and older, as well as certain people under 65 with disabilities or specific medical conditions. Some of the basic benefits can be free of charge, and other benefits have a deductible and a monthly cost.

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Contacting MVP Health Care

(2 days ago) MVP Health Care Attn: Claims Dept. PO Box 2207 Schenectady, NY 12301 Massage Therapy/Chiropractic/ Acupunture Landmark: 1-800-638-4557 Mental Health/Substance Abuse Beacon Health Options (Latham Service Center)—NY Commercial, Medicare, ASO: 1-800-397-1630 (Woburn Service Center)—NY Medicaid, CHP, Essential Plan: 1-844-265-7592

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MVP Health Care

(7 days ago) Medicare Advantage Plans and Part D Prescription Drug and Covered Drug Lists. MVP Health Care Medicare plans provide health insurance benefits for people age 65 years and older, as well as certain people under 65 with disabilities or specific medical conditions. Some of the basic benefits can be free of charge, and other benefits have a deductible and a monthly cost.

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL

(9 days ago) Health care providers who have been sanctioned by the New York State Department of Health Medicaid Program may not participate in the MVP Government Programs network. MVP’s Government Programs follow all regulations required for commercial HMO products as outlined in this manual. MVP’s New York State Government Programs members have access to

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MVP Utilization Management Policy Guide

(Just Now) Rehabilitation (AIR,) and Home Health services for MVP Medicare Advantage members only. naviHealth staff will be located in each of the MVP regions to visit facilities and manage the transitions. To contact naviHealth, visit naviHealth.us or call 1-844-411-2883. Chiropractic Services MVP Health Care has delegated Landmark Healthcare, Inc.

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL – …

(9 days ago) Health care providers may request a copy of the specific criteria used to make a UM determination by calling the Customer Care Center - Provider at . 1-800-684-9286. The criteria will be mailed or faxed to the provider’s office with a proprietary disclaimer notice. Members

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MVP Health Care Launches myERnow, Virtual ER Telemedicine

(1 days ago) MVP Health Care® (MVP) recently announced a new option for members to access free/no-cost virtual emergency room telemedicine services, specifically related to any COVID-19 related concerns. Powered by United Concierge Medicine (UCM), myERnow is a virtual emergency room

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MVP Utilization Management Policy Guide New York State

(1 days ago) MVPCLIN0002 (12/2020) ©2021 MVP Health Care umpolicyguide Prior Authorization Process and Requirements Revised January 2021 New York State This UM Policy Guide provides a quick reference of prior authorizations for all MVP Health Care ® health plans. The guide should be used in coordination with the Prior Authorization Request form (PARF) .

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Healthy Practices Newsletter

(Just Now) Health vision, members’ current 2019 benefits will not be afected. “At MVP Health Care, we are committed to providing our members with the highest quality of care, and in order to achieve this, we believe all health care should be integrated,” said MVP Health . …

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MVP Health Care Specialty Code to Taxonomy Code Crosswalk

(8 days ago) MVP Health Care Specialty Code to Taxonomy Code Crosswalk Specialty Code Specialty Desc Taxonomy Code Taxonomy Provider Type Taxonomy Class Taxonomy Specialization CF MULTI-DISCIPLINARY 275N00000X Hospital Units Medicare Defined Swing Bed Unit.

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MVPPR0047 HealthyPractices v7

(3 days ago) A quarterly publication for MVP Health Care® providers. me built around health insurance Spring 2019 Be Antibiotics Aware: Volume 15 Number 1 Smart Use, Best Care As you already know, inappropriate antibiotic prescribing to outpatients promotes the development of antibiotic resistance, which is a growing public health concern worldwide.

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL – …

(5 days ago) MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL – SECTION 1 . Section1—Contacting MVP Health Care 1. 5 . SNF or Acute Rehabilitation- 1-866-942-7826 • For Commercial, ASO and Medicaid Plans 1-866-942-7826 • For Medicare, please contact naviHealth, Inc. 1-844-411-2883

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL

(9 days ago) MVP Health Care takes great pride in providing our members with the highest quality health care and customer service. However, on occasion, misunderstandings and differences of opinion may occur. The MVP appeal and complaint procedures provide members with a dignified and

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MVP Health Care Cardiology

(3 days ago) ©2015 MVP Health Care, Inc. ICD-10 CARDIOLOGY . IMPORTANCE OF DOCUMENTATION • A significant portion of practice revenues, however, can be attributed to E&M services. • Neglecting the proper documentation and coding of encounters is a common and costly mistake.

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SECTION 15: PAYMENT POLICIES

(1 days ago) MVP Health Care Payment Policy Anesthesia Page 3 of 6 . addressing an emergency of short duration in the immediate area, administering an epidural or caudal anesthetic to ease labor pain, or periodic, rather than continuous monitoring of an obstetrical patient, does

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Cigna Reference Guide

(8 days ago) MVP Health Care Cigna Quick Reference Guide 3-12 Keywords: MVP Health Care, Cigna, Quick Reference, Guide, Provider, 2012 Created Date: 3/20/2012 8:40:06 AM

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National Drug Code (NDC) Payment Policy

(9 days ago) November 9, 2016 #53E National Drug Code (NDC) Payment Policy Requirement Reminder Please note, this is a follow up to our 8/23/16 Fast Fax about MVP Health Care’s NDC policy because some

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OBSTETRICS & GYNECOLOGY

(8 days ago) ©2015 MVP Health Care, Inc. 24 • The primary code is the main reason for the visit - Ensure that the primary code is an appropriate primary code as defined in the guidelines. • Additional codes should be reported where required by coding conventions (“code also”,

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The Primary Care Physician’s (PCP

(6 days ago) Health care providers who have satisfied MVP’s credentialing process (see section 11 for all credentialing information) and have a contract with MVP or a Provider Organization (IPA, PHO, PO) will be listed in MVP’s participating provider directory. This directory is the primary source

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MVP Health Care Payment Policies

(5 days ago) MVP Health Care Payment Policy Anesthesia Page 3 of 6 addressing an emergency of short duration in the immediate area, administering an epidural or caudal anesthetic to ease labor pain, or periodic, rather than continuous monitoring of an obstetrical patient, does not substantially diminish the scope of control exercised by the physician in

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL …

(4 days ago) MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL SECTION 12 . Section 12—New York State Government Programs 12.3 . Department of Health (CDOH), as required by state health codes. MVP also expects the PCP and other providers to cooperate with the CDOH to identify case contacts and arrange for or provide services and follow-up care.

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ICD-10 PEDIATRICS

(4 days ago) ©2015 MVP Health Care, Inc. IMPORTANCE OF DOCUMENTATION • A significant portion of practice revenues, however, can be attributed to E&M services. • Neglecting the proper documentation and coding of encounters is a common and costly mistake.

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UB-92 to UB-04 Paper Claim Form changes

(Just Now) MVP Health Care has developed this guide to help orient you to the key data fields that are changing on the new UB-04 Paper Claim Form that will be required by MVP Health Care beginning 5/23/07. The following example illustrates the changes between the UB-92 claim form and the

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Billing of Anesthesia Modifiers Qualifiers

(2 days ago) MVP Health Care, FastFax, Providers, Billing, Anesthesia Modifiers & Qualifiers Created Date: 7/31/2015 2:02:58 PM

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SECTION 15: PAYMENT POLICIES

(5 days ago) MVP Health Care Payment Policy Allergy Testing and Serum Preparation Claims . Type of Policy: Payment . Last Reviewed Date: 12/1/2018 . Related Polices: N/A . Policy . MVP will reimburse for Allergy testing and Serum preparation. The tests and units of doses …

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OPTHALMOLOGY CODING EXAMPLES

(9 days ago) that is too high for the continued health of the eye. In this case, ICD-10-CM does not have separate codes to identify specific eyes. 5. This patient presents to his physician with continued eye problems following cataract surgery. Ultimately, this is diagnosed as bullous keratopathy, left eye, due to …

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MVP HEALTH PLAN, INC. PROVIDER RESOURCE MANUAL …

(1 days ago) health plan of the request for conversion to inpatient benefit days. The request is subject to review for medical necessity and will be reviewed when all clinical information is received following the standard UM process for concurrent review.

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In-Office Procedure List Update

(3 days ago) MVP Health Care Subject: MVP FastFax East #6: In-Office Procedure List Update Keywords: MVP Health Care, Providers, FastFax, East Region, #6, In-Office Procedure List Update, CVS/caremark, 2015 Created Date: 4/9/2015 3:06:16 PM

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National Provider Identifier (NPI) Q&A

(3 days ago) MVP Health Care, NPI, National Provider Identifier, Participating Providers, Trading Partners Created Date: 4/13/2009 4:05:40 PM

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Frozen Fee Schedule Updates

(6 days ago) MVP Health Care, Provider, Fast Fax, 47 East, Frozen Fee Schedule Updates Created Date: 10/25/2016 9:21:28 AM

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CIGNA NEWBORN CLAIM SUBMISSION UPDATE

(6 days ago) approved the transition timeline for the version 02/12 1500 Health Insurance Claim Form (1500 Claim Form). The new form accommodates ICD-10 reporting and aligns with 5010 requirements. The NUCC approved the following transition timeline at its meeting in August and includes:

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SMOKING CESSATION BENEFITS FOR MEDICAID

(9 days ago) Health Tools & Calculators. Physicians are urged to also advise patients that telephone and online Physicians are urged to also advise patients that telephone and online quit support is available free from the New York State Smokers’ Quitline at 1-866-NY-QUITS (1-866-

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