For Providers

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.

If you need a resource from Vibra Health Plan, please review the options below.

• 2022 Formulary
• Authorization Form
• Authorization Requirements List
• Change Form - Facilities
  • The change form can be found under the Provider Data Updates heading below.
• Change Form - Physician
  • The change form can be found under the Provider Data Updates heading below.
• Clinical Practice Guidelines
• Coverage Determination Form
• EDI/EFT/ERA InstaMed FAQ
• EDI/EFT/ERA InstaMed Network Funding Agreement
• Member Appeal and Grievance Form
• Prior Authorization/Utilization Management FAQ
• Provider Code of Conduct
• Provider Manual
• Waiver of Liability Form

External Resources

• Drug Coverage Prior Authorization
• Provider Look-up

Provider Bulletins

• Notification of Revised Preauthorization Requirements by Code - July 1, 2022
• Notification of Revised Preauthorization Requirements by Code - April 1, 2022
• Healthcare Effectiveness Data and Information Set (HEDIS) CPT II Coding - March 28, 2022
• Preauthorization Changes - Febuary 25, 2022
• Medical Claims and Review Process Implementation - Febuary 25, 2022
• New Prior Authorization Program for Musculoskeletal Surgical Procedures - Update January 24, 2022
• New Vendor for Medical Necessity Reviews for Advanced Imaging Services - December 17, 2021
• Digital Diabetes Programs - December 14, 2021

• New Paper Claims Address - As of January 1, 2020, paper claims should be sent to:
  • PO Box 21199, Eagan, MN 55121
• 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.