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

Updated October 1, 2021