MVP Health Care
Welcome to the MVP Health Care® (MVP) Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, Charmaine Everett.
Magellan Healthcare and MVP Health Care® revised the implementation date of non-emergent Musculoskeletal procedures requiring prior-authorization to December 1, 2018 for procedures scheduled on or after January 1, 2019.
RadMD and the Magellan Healthcare Call Center will be available on December 1, 2018 to start accepting prior-authorization requests for dates of service on or after January 1, 2019. This program will include all lines of business, including select self-funded plans administered by MVP Health Care. Please contact Provider Services to verify if the self-funded plan requires review by Magellan Healthcare.
Update on COVID-19
- MVP Utilization Management Changes due to COVID-19
- Elective Procedures - Prior Authorization Requirement Update - June 4, 2020
Musculoskeletal (MSK) Management Program
- Interventional Pain Management Utilization Review Matrix-2022
- Spine Surgery Utilization Review Matrix-2022
- Hip, Knee and Shoulder Surgery Utilization Review Matrix-2022
- MSK Quick Reference Guide for Ordering Physicians/Surgeons
- Frequently Asked Questions - Interventional Pain Management Program
- Frequently Asked Questions- Hip, Knee, Shoulder & Spine Surgeries
- MSK Provider Training Program PowerPoint
- Checklist- Interventional Pain Management
- Checklist- Spine Surgery
- Checklist- HIP, Knee, Shoulder Surgery
- Coding Reference Guide-Spine Surgery
- Coding Reference Guide-Hip, Knee & Shoulder
- Peer-to-Peer Process
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD Documents
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
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Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
Clinical Guidelines
- Clinical Guidelines
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Refer to the Utilization Review Matrix document to view specific codes managed by Magellan Healthcare
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).