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