Category: Updates

Posted in #Medicareadvantage, MVP (NY/VT) Insurance Payer, Prior Authorization Insurance Carrier Updates, Updates

MVP to end its relationship with naviHealth, Inc

Posted on by KR2Medical Billing

Currently naviHealth, Inc handles Utilization and Case/Care Management for post-acute services—including Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), and Home Health—for MVP Medicare Advantage, DualAccess, and DualAccess Complete Members.

However, MVP and naviHealth, Inc will end their contract as of Dec 31st 2025.

Starting on Jan 1,2025 MVP will process these requests in house.

More information to come in Nov 2025.

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Posted in MVP (NY/VT) Insurance Payer, NY Medicaid EHR incentive program, NY Providers, Payers and CPT reinbursement, Updates

MVP postpartum program incentive payments: NY providers!

Posted on by KR2Medical Billing

Are you any of these following providers in NY?

OB/GYN Family Medicine Certified Nurse Mid-wives Nurse Practitioner – Family Health

Then this blog post is for you!

NY DOH established an additional payment (to global OBGYN bundled payment) for providers that complete a person-centered postpartum visit— including a depression screening—within 12 weeks of delivery, as per ACOG/AAP guidelines.

In order to qualify for this additional payment the postpartum services need to be related to deliveries that occurred from July 1, 2024, through March 31, 2025.

Coding that qualify for this program are:CPT II Code 59430 or 0503F

Please bill these codes with $0

This program only applies to Managed Medicaid Care Plan type.

The additional payment amount is $125.

The payments are maid quaterly basis.

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Posted in #reimbursement, EmblemHealth NY, NY Providers, Payer Updates, Training, Updates

EmblemHealth/Connecticare/Molina Health update

Posted on by KR2Medical Billing

Are you a provider in CT or NY that serves EmblemHealth/Connecticare members-this blog post is for you!!!

Back in July of 2024, EmblemHealth announced and entered into an agreement with MolinaHealth to sell ConnectiCare (a company part of EmblemHealth).

In a Feb 2025, the sale was finalized.

So what does this mean to you as a provider?

EmblemHealth put together a reference table that the providers can utilize to check the plan/network information and which area that plan/network covers, plus description of the plans; ex deductible, copay, OON benefits, etc.

Image via EmblemHealth website.

Please visit here to view the PDF version of the whole document.

Molina also created a FAQs section that you can access from the same EmblemHealth website.

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