Provider Credentialing and Registration

Per the New York State Department of Health (NYS DOH), health plans are required to identify those physicians who have identified themselves as HIV/AIDS specialists and to list those physicians in MVP Directories. 

Following the NYS DOH criteria, we created an “Identification and Notification of HIV/AIDS Specialist Attestation Questionnaire” (below) which physicians may complete and return to the MVP Credentialing Department. Physicians who return the completed form and are found to meet the NYS DOH criteria will be listed in MVP directories under the additional specialty of HIV/AIDS Specialist.

HIV/AIDS Attestation Questionnaire 

All practitioners have the following rights:

• The right to review information received in support of their credentialing application.
• Applicants have the right to review the information obtained from any outside primary source that is presented to the Credentials Committee in support of their credentialing and/or recredentialing application. For example, malpractice insurance carriers or state licensing boards.  However, we must have written consent (such as verification of hospital privileges or previous employment) from third party sources before we can release that information to the applicant.  Recommendations, letters of reference and other peer review protected information are not subject to this disclosure. (Note: MVP cannot disclose NPDB documentation. Practitioners must request a copy of their report directly from the NPDB.) 
• Upon receipt of an applicant’s written, signed, and dated request, we will release under confidential cover to the applicant by Delivery Confirmed or Certified Mail, Return Receipt Requested all the allowed information that is presented to the Credentials Committee in support of their credentialing/recredentialing application. 
• The right to correct erroneous information submitted during the
  credentialing/recredentialing process. Should the Credentialing Staff receive information that differs substantially from the information provided by the practitioner, a member of the Credentialing Department staff will notify the practitioner, in writing, of the discrepancy.
• The right to be informed of their credentialing or recredentialing application status. MVP, upon applicant’s direct verbal or written request, will notify him/her of the status of their application. 

State of New York 

MVP shall complete a review of the health care professional’s application to participate in the in-network portion of our network and shall, within 60 days of receiving a completed application* and all required documentation to participate in the network, notify the health care professional as to: 

• Whether he/she is credentialed; or
• Whether additional time is necessary to decide because of a failure of a third party to provide necessary documentation, or if additional information is necessary, the notice to the health care professional must identify all additional information needed by the plan to make its determination. In such instance where additional time is required because of a lack of necessary documentation, the plan shall make every effort to obtain such information as soon as possible and shall make a final determination within 21 days of receiving the necessary documentation. 

Note: For applicants that are (1) newly licensed health care professionals or (2) a health care professional who has recently relocated to New York from another state and has not previously practiced in New York; and who are joining a participating group in which all Members of the group currently participate with MVP, the applicant shall be eligible for provisional credentialing as of the 61st day of the application if: 

• The applicant has submitted a Completed Application and any requested supporting documentation; and 
• The applicant provided written notification to the MVP Director of Credentialing, including a statement that in the event the applicant is denied, the applicant or the applicant’s group practice: 
  
  • Shall refund any payments made for in-network services provided during the period of provisional credentialing that exceed out-of-network benefits under the insured’s contract with MVP; and 
  • Shall not pursue reimbursement from the insured, except to collect the copayment or coinsurance that otherwise would have been payable had the insured received services from a participating MVP practitioner. 

 A Completed Application* for Credential and Recredential includes: a complete and accurate CAQH application, re-attested to within the last 90 days, plus all supporting documentation including, but not limited to malpractice insurance certificate, continuity of care arrangements that meet MVP criteria for specialty, explanation of any affirmative responses including malpractice suits, an explanation of any work history gaps of over six months, a re-entry plan for all gaps over one year, and MVP’s receipt of all verifications from third party sources. The practitioner is obliged to provide MVP with information sufficiently detailed to render an opinion regarding any affirmative response. 

The following practitioner types do not require credentialing but must be registered with MVP: Hospitalists (Internal Medicine, Pediatric or Family Medicine), Emergency Department Physicians, Hospital-based Pathologists, Hospital-based Anesthesiologists, Neonatologists, Certified Registered Nurse Anesthetists, Nurse Practitioners working in a physician practice who do not act in the capacity of a primary care provider, and Physicians Assistants. Fill out the Provider Application Request. 

Exceptions: Anesthesiologists who want to be designated as Pain Treatment Specialists, as well as Hospitalist physicians, Emergency Department physicians, Anesthesiologists, and Pathologists who work outside of the inpatient setting must be credentialed. 

• NY Small Group HMO (PDF) 
• NY Small Group EPO/PPO (PDF) 
• VT Small Group HMO (PDF)

• NY Large Group EPO/PPO (PDF) 
• NY Large Group HMO/POS (PDF)
• NY Large Group EPO/PPO (PDF) 

• Medicaid & Child Health Plus (PDF)  
• HMO-POS – Employer Group (PDF)
• HMO-POS Plans – Direct Bill (PDF) 
• MSA – Medical Savings Account (PDF)
• PPO – Employer Group (PDF)
• PPO Plans – Direct Bill (PDF)