Text Size: Contact Us For Brokers For Providers Member Sign-In View the Vibra Health Plan PPO benefits for 2021. Important Provider COVID-19 Information COVID-19 FAQ | COVID-19 Information Effective 8/1/21 Vibra Health Plan will no longer bypass authorization rules for COVID-19 related diagnoses. Standard authorization rules will apply. You are here For Providers For Providers Access the Provider Portal Resources for Providers Join Our Network New Group Request Form Behavioral Health Providers - Areas of Expertise Form 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. Provider Education - Preventive Screening Guide Documents and Resources 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 Physician Participation Agreement Prior Authorization/Utilization Management FAQ Provider Code of Conduct Provider Manual Waiver of Liability Form External Resources Drug Coverage Prior Authorization Provider Look-up 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. Important Reminders 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. Provider Data Updates Please notify us immediately of any practice changes that affect the provider directory or claims reimbursement. These changes might include: Add a provider Remove a provider Add a service location Update phone numbers All changes can be submitted using the following forms: Change Form - Facilities Change Form - Physician Provider Training Modules CMS requires training in compliance as well as fraud, waste and abuse for all providers and their staff who provide services under Medicare Advantage and Part D products. Access training for Medicare Parts C and D: Learn about the intricacies of compliance using the U.S. Department of Health and Human Services' Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. Fraud, waste and abuse / general compliance training Access the provider portal to view the latest training.. Providers should review this training and attest to the following: I have reviewed and understand the healthcare provider training program sponsored by the U.S. Department of Health and Human Services Office of Inspector General and understand that providers are to establish and comply with internal policies and procedures to ensure compliance with the existing laws and guidelines that protect against healthcare fraud, waste, and abuse. Get in Touch For provider support, please contact Vibra Health Plan at 844.440.4629 (TTY 711). Updated October 1, 2021 H9408_WBST22_M For Brokers For Providers Member Sign-In Careers Legal Information NonDiscrimination and Foreign Language Assistance Code of Conduct External Site Disclaimer Site Privacy Report Fraud Sitemap User Categories Terms and Conditions Provider directory API access guide Out-of-network/non-contracted providers are under no obligation to treat Vibra Health Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Every effort has been made to ensure that this site is accessible to all people and groups. If you have any questions or comments on the site's accessibility or usability, please contact us at 844.388.8268 (TTY 711). Vibra Health Plan is a PPO with a Medicare contract. Enrollment in Vibra Health Plan depends on contract renewal. Medicare beneficiaries may also enroll in the Essential Advocate PPO or Enhanced Complete PPO plan the CMS Medicare Online Enrollment Center. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, copayments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. © 2021 Vibra Health Plan. All Rights Reserved.