Medical Claims and Review Process Implementation

Effective May 1, 2022

VHP will implement a Medical Claims and Review (MCR) process. MCR performs medical necessity reviews on post-service, pre-payment claims.

Please note:

• This process does not replace the need to obtain Preauthorization.
• Retrospective Review requests that previously allowed authorizations to be obtained for up to 60 days post-service but pre-claim submission will no longer be permitted. Failure to follow preauthorization rules will be applied as defined in the Provider Manual.

• If you received a claim rejection with message "M127: Missing patient medical record for this service", please submit medical records and claim number within 10 days to:

  Vibra MCR
  Fax: 717.651.4235

  Mailing Address:
  Vibra Health Plan
  ATTN: Medical Claims Review
  PO Box 60250
  Harrisburg, PA 17106-0250