Prior Authorization Request Process

Published April 2024

MVP is committed to authorizing the appropriate course of care to our Members in a timely manner. In addition to completing the appropriate Prior Authorization (PA) Request Form to meet your patients’ needs, we ask that you do not submit duplicate requests for the same medication, equipment, or service, as it may cause your prior authorization review to be delayed. All MVP Prior Authorization forms can be found here.

When will MVP contact you regarding your prior authorization request?

• PA Requests for Medications - MVP will provide a response within the contractual timeframe, but no more than 72 hours if all necessary clinical information has been provided
• PA Requests for Durable Medical Equipment - MVP will provide a verbal response within 24 hours or one business day of making the decision. A written response when the decision is finalized is mailed as soon as possible
• PA Requests for all other services - MVP will provide a response within 24 hours or one business day of making the decision. A written response when the decision is finalized is mailed as soon as possible

Please make sure all necessary clinical information is provided on the prior authorization request so that MVP can quickly made a determination without the need to reach out for more information.

*When is it appropriate to submit a request after one has already been submitted?

• Changing date of service
• Adding a service
• Submitting additional information
  • If submitting an updated request, please indicate what is different

How can I find out if prior authorization is required?

Sign into your MVP Provider online account for a list of medications, equipment, and services that require PA.

If you have questions about the PA request process, timeframes, or duplicate requests, please contact your MVP Professional Relations Representative.

How can I determine the status of a prior authorization that has already been submitted?

Providers are strongly encouraged to submit pharmacy PA requests through their MVP Provider online account and using NovoLogix. Once signed in, you can see in real time the status of all PA requests you have submitted.