News from the NIC - MVP

The NYSCA Insurance Committee (The NIC) is bringing you the latest updates on MVP.

As some of you have reported, the Initial visit (new patient eval and treatment) rate of $80 was processed at the Subsequent visit rate of $60 when both the initial visit and subsequent visits were billed on the same CMS-1500 claim form.   MVP is pleased to announce that effective immediately, both Initial Visit and Subsequent Visit(s) can be billed on the same claim and the claim will process correctly.  In addition, MVP will be running reports to identify and proactively reprocess any claims containing and Initial and Subsequent visit which were not processed correctly.  There is no need to resubmit previously submitted claims.

In addition, MVP has updated their payment system to allow payment at the lesser of billed charges or contracted amount ($80 Initial visit, $60 Subsequent visit).  This will address those members with high deductible plans that are responsible for a higher cost share than what the provider is billing.  Note that this update is consistent with claims processing from other carriers, as well as the terms of your MVP contract.  It will also allow for easier bookkeeping in your office.

As always, make sure you add the -25 modifier to your Evaluation and Management (E/M) procedure when billing an E/M service and treatment on the same visit.

If you have any questions regarding the above, please do not hesitate in asking.

The NYSCA would like to thank those members who have brought these concerns to our attention, and to MVP for acting quickly to resolve them.

Together We Are NYSCA

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