Provider Reference Library Home Page
Access MVP Health Care’s Provider Reference Library for coding guidelines, access standards, onboarding tools, EDI resources, and policy updates to support your practice.
MVP is participating with CAQH to utilize their Provider Data Portal
As of July 1, 2025, MVP has expanded our relationship with CAQH to begin using their Provider data management and validation solution. Read more about what this means to you.
Access and Availability Standards
Providers are required to provide access within specific timeframes based upon the acuity of the patient, MVP product coverage, and specialty of the Provider. The following resources provide details about the requirements by Line of Business (LOB).
|
Line of Business |
Product |
|---|---|
|
Commercial |
HMO Commercial Small/Large Group |
|
Government Programs |
Medicaid Managed Care |
|
Essential Plan |
Essential Plan (EP)* |
|
Medicare |
Medicare Advantage |
*EP follows NY Medicaid Health Access Standards
Coding, Medical Record Documentation and Education
Find helpful information and resources about coding and documentation (including ICD-10-CM 2021 Coding Guidelines) on our Medical Coding page
EDI Information and Guides
Find helpful information including MVP’s Payor ID and information about online claim submission, EDI options, guides, and where to find help on our EDI Information and Guides page
Education Resources
MVP Health Care has developed many educational resources to help keep our Providers informed and ensure successful partnerships.
View MVP Provider EducationFastFaxes
View all Provider FastFaxes
Gia® by MVP
MVP understands the increasing demands on Providers when it comes to meeting patient needs. Between the health crisis emergency we’re facing and the over utilization of Emergency Rooms and Urgent Care facilities, the health care system is overwhelmed. The Gia by MVP mobile app is available 24/7 and allows Members to speak to live doctors who can triage Members and help them get the care they need, either by answering questions, diagnosing and treating when possible, or referring to in-person care from nearby doctors, specialists, labs, and pharmacies when needed. Gia is also a guide to an MVP Member’s health plan. Members can search our network of PCPs, specialists, and facilities, view and share their MVP ID cards, see claims, and more!
Learn More about Gia by MVP
Onboarding for MVP Providers
Providers new to the MVP network can find all the information and resources to successfully Onboard with MVP, including how to get started, required trainings and attestations, and helpful MVP resources.
View information on MVP Provider Onboarding
Provider Policies and Payment Policies
Find details about our Provider Policies and Payment Policies
Utilization Management
Other Helpful Resources
-
Vermont Act 111 (Bill H.766)
MVP Health Care® (MVP) is committed to keeping Providers informed of changes that impact their practice and patients. One such change is Vermont Bill H.766, signed into law as Act 111.
View changes to Vermont Act 111 (Bill H.766) effective January 1, 2026.
-
Cigna HealthCareTo understand MVP’s National Alliance with Cigna, review the CIGNA Reference Guide.
-
COVID-19 Updates for ProvidersCOVID-19 Public Health Emergency (PHE) Unwind Updates
-
Health Home
-
HEDIS Provider Reference GuidesFind general references, as well as information about gaps in care, child and adolescent care, adult conditions, preventive care, diabetes, and women’s and behavioral health on our HEDIS Reference Guides page.
-
ICD-10 Updates and FAQsThe 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
-
Medicaid Management Information System (MMIS)
-
MVP Benefits & Plans
-
MVP Online Accounts
-
MVP Policies
- Code of Ethics and Business Conduct Summary
- Corporate Code of Ethics and Business Conduct
- Detecting and Preventing Fraud, Waste and Abuse
- Independent Dispute Resolution Process for Emergency and Surprise Bills—Health Care Providers
- Medical & Pharmacy Policy Updates Archive (Login required. Once you are logged in, hover over Resources, then click Medical Policies.)
- NPI Information
-
MVP USA Care PPO® planUSA Care PPO from MVP Health Care is a Medicare Advantage PPO plan with no Provider network restrictions and no direct Provider contracts with MVP required. Learn more on our MVP USA Care Plan page.
-
New York State Medicaid Programs for ChildrenOur New York State Medicaid Programs for Children page contains detailed information on the Transition of Children in Voluntary Foster Care Into Medicaid Managed Care (including trainings), Children and Family Treatment and Support Services (CFTSS), Youth Peer Support and Training, crisis intervention, as well as coverage and eligibility information.
-
OnTrackNYOnTrackNY 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 do not. OnTrackNY helps people achieve their goals for school, work, and relationships.
-
Opioid/Pain Management Resources
-
Project TEACHProject 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 by reviewing our web session below, or in our Healthy Practices Newsletter -
Support Services for ChildrenFind support services from national organizations and New York State agencies that can help children and families during difficult times.
-
Vermont Gold Card Prior Authorization Pilot Programthe Vermont Gold Card Prior Authorization Pilot Program seeks to eliminate or streamline certain prior authorization requirements. The Vermont Gold Card Prior Authorization Program is for Commercial and Exchange Members in Vermont. Learn more on our Vermont Gold Card Prior Authorization Pilot Program Page.
-
Zelis EFT/ERA
Enroll with Zelis
You can register at mvp.epayment.center or call 855-774-4392 to receive claim payment data and remittances electronically.