INSURER FILING GUIDE
MVP Health Care
Use this public information to prepare your packet, then confirm the route on the insurer's own page.
AT A GLANCE
Claim facts
| Member form | MVP Claim Reimbursement Request Number: MVPform0153 / Y0051_5251_C Revision: 2025-08 (printed in month/year order) Open the insurer form |
|---|---|
| Portal upload | YES |
| Portal path | Sign In > Medical Claim Reimbursement |
| Mail address | CLAIMS SUBMISSION, MVP HEALTH CARE, PO BOX 2207, SCHENECTADY NY 12301-2207 |
| Fax | 518-395-1395 |
| Attachments | Provider name and address on letterhead; provider Tax ID; provider NPI; patient full name; health plan identification number; HCPCS or CPT code for each service; place of service; date and charge for each service or supply; ICD-CM code; other carrier explanation of benefits when applicable |
| Deadline | 120 days after the date of service under the published 2026 New York large-group PPO contract |
| Outcome and status | Gia account > claim status |
| Processing time | 30 days for an electronically submitted clean claim; 45 days for another clean claim under the published New York contract |
| Caveats | Only current members age 18 or older may use the online route. The form requires both pages for non-Medicare members. Medicare Advantage and Medicaid are outside this read. |
STEP BY STEP
Filing steps
Read date: 10-09-2026
Research steps
- Confirm that the plan has out-of-network reimbursement. The published 2026 New York large-group PPO contract requires a claim within 120 days after service, while the controlling plan may differ. https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/cocs/2026/ny-lg/ny43-ppo-coc-gf-2026.pdf
- Sign in to the MVP online account and select Medical Claim Reimbursement. The online route is limited to current members age 18 or older. https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/forms/member/claim-reimbursement-form.pdf?hash=CCD7D9248BB9990E4EA44EE6802A338C&rev=baa68dbe2e464ce9a2fd11f702265065
- Submit a separate reimbursement request for each bill. Include itemized proof-of-payment receipts and original provider bills with every provider, patient, code, place, date, charge, and diagnosis field listed by MVP. https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/forms/member/claim-reimbursement-form.pdf?hash=CCD7D9248BB9990E4EA44EE6802A338C&rev=baa68dbe2e464ce9a2fd11f702265065
- Sign the certification. A non-Medicare member must submit both pages and sign the Assignment and Release. The form offers no box that keeps payment with the member, so payment destination is NOT PUBLISHED for this package. https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/forms/member/claim-reimbursement-form.pdf?hash=CCD7D9248BB9990E4EA44EE6802A338C&rev=baa68dbe2e464ce9a2fd11f702265065
- Check claim status through the Gia account. NOT PUBLISHED: portal file types, file-size limit, maximum files, packaging, and submission confirmation. https://prod-sitecore-cd.mvphealthcare.com/members/resources/manage-account
Filing facts
- Portal upload: YES
- Portal: MVP online account through Gia
- Portal path: Sign In > Medical Claim Reimbursement
- Mail address: CLAIMS SUBMISSION, MVP HEALTH CARE, PO BOX 2207, SCHENECTADY NY 12301-2207
- Fax: 518-395-1395
- Attach: provider name and address on letterhead; provider Tax ID; provider NPI; patient full name; health plan identification number; HCPCS or CPT code for each service; place of service; date and charge for each service or supply; ICD-CM code; other carrier explanation of benefits when applicable
- File types: NOT PUBLISHED
- File size limit: NOT PUBLISHED
- Maximum files: NOT PUBLISHED
- One file or separate files: Submit a separate reimbursement request for each bill and include itemized receipts showing proof of payment plus original provider bills
- Confirmation: NOT PUBLISHED
- Status check: Gia account > claim status
- Processing time: 30 days for an electronically submitted clean claim; 45 days for another clean claim under the published New York contract
- Member deadline: 120 days after the date of service under the published 2026 New York large-group PPO contract
- Deadline basis: The controlling plan document may differ; HMO and EPO plans may lack ordinary out-of-network benefits
- Mental health route: MVP behavioral health
Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.
Read on 10-09-2026 from https://www.mvphealthcare.com/-/media/project/mvp/healthcare/documents/forms/member/claim-reimbursement-form.pdf?hash=CCD7D9248BB9990E4EA44EE6802A338C&rev=baa68dbe2e464ce9a2fd11f702265065. Confirm the address, fax number or portal path on the insurer's own claims page before you send.