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Our Provider Value Proposition
Vibra Health Plan will work closely with physicians, hospitals, and health systems to improve quality, increase collaboration and decrease costly, burdensome processes by:
- Aligning physician reimbursement with incentives to provide quality care and increase patient satisfaction.
- Implementing physician-focused approaches to care management.
- Developing and nurturing strategic partnerships.
- Assisting patients and their caregivers in navigating the healthcare system.
- Innovating benefit design to promote prevention and patient compliance.
Quality Improvement Program
Vibra Health Plan is committed to partnering with our network to bring our members exceptional care. Our program is focused on evaluating, measuring and improving the quality of care and service provided to our members.
Documents & Resources
If you need a resource from Vibra Health Plan, please review the options below.
- Authorization Form – In Effect 1/1/17
- Authorization Requirements List – In Effect 3/1/17
- Change Form - Facilities
- Change Form - Physician
- Clinical Practice Guidelines 2017
- Coverage Determination Form
- EDI Claims Quick Reference Guide
- EDI Remittance Quick Reference Guide
- EDI/EFT/ERA InstaMed FAQ
- EDI/EFT/ERA InstaMed Network Funding Agreement
- Electronic Services – Claims EDI/EFT/ERA
- Enhanced Formulary
- Essential Formulary
- Join Our Network
- Member Appeal and Grievance Form
- Physician Participation Agreement
- Prior Authorization/Utilization Management FAQ
- Provider Code of Conduct
- Provider Directory
- Provider Education Webinar
- Provider Manual
- Provider Quick Reference Guide
- Waiver of Liability Form
Coverage Determination Language
Vibra Health Plan uses Local Coverage Determinations (LCDs), which are established by the local Medicare Administrative Contractor. LCDs establish policy on whether to cover a particular service and are used in processing claims for payment. The LCDs are located on the Novitas Solutions website, medical policy portal.
- Medicare Outpatient Observation Notice (MOON) – Hospitals must deliver to any beneficiary who receives observation services as an outpatient for more than 24 hours. Must be signed by the patient; form will be available on Provider Portal.
- Dual eligible enrollees cannot be balance billed – Federal law prohibits Medicare providers from collecting Medicare Part A and Part B deductibles, coinsurance, or copayments from anyone enrolled in the Qualified Medicare Beneficiaries program. Low income subsidy copayments still apply for Part D benefits.
- Anti-discrimination based on payment status – Providers may not refuse to serve enrollees because they receive assistance with Medicare cost-sharing from a State Medicaid program.
* Highlighted counties represent Vibra Health Plan's service area
Get In Touch
For provider support, please contact Vibra Health Plan:
- Toll-free: 1-844-440-4629 (TTY 711)
- Email: email@example.com
- Fax: 717-963-7734