Tag: #MVPNY

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

MVP (NY/VT): COVID-19 Treatment and Virtual Care, Cost-Share Update

Posted on by KR2Medical Billing

Below policy will apply to MVP plans that are located in New York and Vermont.

New York Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.

Vermont Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.

New York Covid-19 Treatment member Cost-Share:

Effective August 1, 2021, MVP will no longer waive the cost-share for COVID-19 treatment.

***Vermont Covid-19 Treatment member Cost-Share: ***

MVP will continue to cover COVID-19 treatment in full until March 1, 2022 as is required by
Vermont Rules.

COVID-19 Testing Member Cost-Share: NY &VT

MVP will continue to cover COVID-19 testing in full in New York and Vermont

COVID -19 Testing Coding and Billing Corner:

As of January 1, 2021 claims billed with a diagnosis code Z03.818 in conjunction with a COVID19 testing procedure code will be denied

MVP will retain the expanded set of codes eligible for telehealth, consistent with CMS guidance, and will continue to monitor state and federal guidelines and regulations. In addition, MVP supports continued telehealth reimbursement and is currently reviewing coding guidance.

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

MVP (NY) COVID-19 Vaccine Proper Billing and Coding guidance

Posted on by KR2Medical Billing

The following medical billing and coding Guidance, for COVID-19 vaccines, ONLY applies to New York Providers.

As per MVP: ALL COVID-19 vaccines are covered for all PLANS without a member cost-share.

In order to get reimbursement, providers need to follow the proper COVID-19 vaccine billing and coding guidance.

For MVP Medicare Patients:

Providers please bill Medicare Fee-for-Service (FFS) directly for the vaccine and administration of the
vaccine to MVP Members enrolled in Medicare Advantage in 2020 and 2021. If Providers will bill the COVID-19 claims to MVP, they will be denied.

For MVP Commercial and Managed Medicaid Patients:

Since COVID-19 vaccines are provided by the government at no charge, Providers should not bill the Vaccine codes (please see below Picture 2). Instead providers should only bill the administration codes (see below Picture 1).

(Picture 1)
(Picture 2)

MVP will reimburse both In Network and Out of Network providers.

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

MVP NY – Home Health Approval Process-New 2021

Posted on by KR2Medical Billing

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.