Watch for MVP Preferred Health Plan Members in 2008

As of January 1, 2008, many Preferred Care employees and workers at several Rochester-based employers will be active members in one of our new MVP Preferred EPO or PPO health plans.

At this new stage of integration, it is once again important to note that the member’s plan type is the primary driver of the procedures you need to follow.

MVP Preferred members will present a Member ID Card with both the MVP Health Care and Preferred Care logos, like the sample shown here. The back of the card shows you the phone number and address to use for claim administration and questions.

Click on ID card image to see larger

Important note: If your patient is a TriVantage EPO plan member, you will see a code on the card that denotes the member’s coverage. You can use the “Copayments for Office Visits, Inpatient Admissions” grid shown here to crosswalk the code to the corresponding coverage.

To assist you in serving MVP Preferred members click the links below:

• MVP UM Policy Guide for New York
• Prior Authorization Form
• Crosswalk Grid
• Provider Resource Manual (for Preferred Care providers treating MVP Preferred members)

You will receive a new MVP Preferred Provider Resource Guide in January 2008 with further details. Opportunities to attend 2008 educational sessions will be announced by FastFax; we also invite you to request a site visit with your Professional Relations representative if you have specific, complex questions.

Posted: April 17, 2007

Preferred Care providers seeing MVP members / Integrated Network

Effective January 1, 2007, Phase one of MVP and Preferred Care’s integrated network will be in place. The network will stretch from Buffalo, New York to the Atlantic coast of New Hampshire, and will permit members of one health plan to access providers who have agreed to see members of the other plan. For example, a Preferred Care PPO member who lives in Rochester, New York may access an MVP provider in Albany, New York and vice versa. Click here for a list of commonly asked questions and answers about the Integrated network initiative.

The member’s plan is the primary driver of any procedures you need to follow for the integrated network.

If you have not received an Amendment to your contract to treat MVP members, please contact your Contract Representative.

The guidelines below describe the operational and service processes related to accessing MVP for eligibility, pre-authorization and claims submission/processing.

Last updated: January 1, 2008