News from the NIC - August 2022 - MVP

Warm Greetings from the NYSCA Insurance Committee! This summer has brought forth several important changes and deadlines which have impacted how you interface with payers.  The NYSCA Insurance Committee (The NIC) has been inundated with calls, especially with the new Workers' Compensation requirements and the new MVP program effective 1/1/23. This article will address questions related to the New MVP program. Workers’ Compensation will be addressed in a separate piece.

MVP Chiropractic Network

As you are aware, MVP is developing a new chiropractic network. Although the NYSCA cannot advice whether to contract with any company, we have been in contact with MVP to obtain answers to your questions (noted below). 

The new MVP program becomes effective on January 1, 2023.  You must contract directly with MVP to receive in network benefits.  As noted in our last News From the NIC, credentialing and contracting takes time.  MVP has set a September 1, 2022 deadline to receive contracts from interested doctors. 

High Tech Imaging

We have just received confirmation that doctors of chiropractic will be able to order high tech imaging when medically necessary for MVP insureds.  Further details will be forthcoming on the details of that aspect of the program and process (currently MVP utilizes Evicore as their third-party for high tech imaging for other health care providers).

Q&A from MVP’s Professional Relations Department

The following additional information has been shared via MVP's Professional Relations Department:

  • Q: May a doctor of chiropractic order medically necessary lab tests (e.g., blood / urine)?
    A: MVP will allow medically necessary lab tests to be order by chiropractors.  Patients must be referred to an in-network lab for the test.  Here is a link to the Provider Search on our website:  MVP Health Care - Search homepage (
  • Q: Reimbursement for medically necessary services is based upon the fee schedule and in accordance with the patient / member benefit.  Although this is clear, there is a follow up question - Is there a range of visit caps per plan type that can be anticipated (e.g., HMO, EPO, Healthy NY, etc)?
    A: At this time, there is not a maximum number of visits a member is allowed.  Benefits are based on individual member plan design.
  • Q: What is the definition of an 'initial visit' in the Chiropractic Fee Schedule as compared to a follow up visit?
    A: An initial visit would be the first time a provider is seeing the patient for a full medical evaluation, consistent with all other physician specialty guidelines.  All visits after the first visit would be a follow-up visit. Exacerbation and recurrence is equivalent to an office visit which is the policy for other physician specialties.
  • Q: What about follow-up E&M visits? An initial visit for a new condition/injury, following a significant lapse in care, or a significant change in a patient's condition are common scenarios which require an in-depth evaluation to arrive at a working diagnosis and recommended plan of care.  There are well established and accepted guidelines and algorithms which recommend appropriate evaluations under various scenarios and timeframes. 
    A: Claims billed with a different diagnosis code would be considered a follow up visit to an already established patient.  This is consistent with other physician specialties
  • Q: Does the same fee schedule apply to MVP's Medicare Replacement / Advantage population?
    A: Yes, the fee schedule is for all products. 
  • Q: Can you provide the rationale for the 10-year requirement for medical records retention?
    A: CMS requires that for a Medicare managed care program provider, patient records must be retained for 10 years.


Those NYSCA members who continue to experience challenges with eviCore's 3/1/22 pre-authorization program for MVP insureds may submit BLINDED examples to NYSCA via fax to 518-785-6352. 

As noted in our last News From The NIC, MVP was able to provide further guidance based upon information received from eviCore. The NIC would like to remind you to always retain a log as you would with all your insurance company contacts (reference number, time and date of a call, or screenshot of the provider portal which indicates an authorization is not required).  Maintain this information (on paper or electronic in the EHR) in your insurance or patient's folder for easy access if a claim is denied contrary to your inquiry.  

NYSCA Virtual Membership Meeting

For additional information and to keep present on issues that affect our profession and the care of your patients, please join us on Wednesday September 7th at 8pm for our next regional meeting. 

Register Today!

As always, thank you for your continued dedication.

Together We Are NYSCA!

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