Posted in MVP (NY/VT) Insurance Payer, Pharmacy (Various Insurance Payers), Training, Updates

NY Managed Medicaid Plans Reimbursement Update: Pharmacies 05/01/2021

Starting 05/01/2021– The prescriptions will no longer be covered and paid under the Managed Medicaid Plans (ei. MVP). Instead the prescriptions will be covered under NY Medicaid Fee for Service Fee Schedule.

Where can I find the list of covered medications?

  1. Medicaid Fee for Service has a list of covered medications. OTC (over the counter medications and most other medications are on that list. The list can be found on emdNY website.
  2. Medicaid Fee for Services also has a preferred medication list. This list can be found by clicking here.

Do I have to participate in NY Medicaid Fee for Service?

As a pharmacy (provider) you will need to participate in NY Medicaid Fee for Service, in order to fulfill the Managed Medicaid Patient RXs.

What else do I need, in order to process claims?

A Managed Medicaid Member has to show you their NY Medicaid Card or your Health Plan Card. As a Participating Pharmacy Provider you will need the CIN number in order to file your claims.

For General Information and Updates please click here.

Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP NY – Home Health Approval Process-New 2021

This new process is an auto-approval, that would streamline the first time initial HH request.

This policy change applies to all MVP Medicare Advantage Members requiring HH admissions.

Provider will have to send in their request through naviHealth.

The providers will receive 10 pre-approved visits, which would include the Start of Care (SOC) visit.

Starting 01/01/2021- naviHealth will utilize Change Healthcare’s InterQual home health criteria for continued stay requests, additional services, and recertification’s.

Education:
• naviHealth will provide educational webinars (Details to come)
What will the webinars include?
• An overview of the new HH auto-approval process
• A detailed look at the revised naviHealth HH authorization request form
– There will be an opportunity for questions & answers
Who should attend?
• HH agency billing/Insurance areas
• HH agency intake department manager

Please contact the naviHealth Senior Clinical Manager, Monica Bean at mbean@navihealth.com with any questions.

Source: MVP fax Provider Communications.