DualAccess Cost Share and Training Update

Published April 2024

MVP Health Care® (MVP) offers an MVP DualAccess plan, which is a Dual Eligible Special Needs Plan (D-SNP) that serves individuals who are dually eligible for Medicare and Medicaid in the Capital District, Hudson Valley, and Monroe County.

As a reminder, Participating Providers should not collect any cost-share from DualAccess Members unless specifically stated in their Subscriber Contracts.

Exceptions may include:

• Eyewear allowance benefit could result in a Member cost-share if the allowance is exceeded
• Members who see a non-participating provider will be 100% responsible for services received
• Members who are advised by their Provider in writing that item/service is not covered and Member is liable for payment. Providers may then collect permissible cost-shares

Please submit a claim to MVP and the D-SNP portion of the Member’s plan will pay what Medicare would traditionally pay. If there is a balance, Medicaid will cover it. Please bill the Member’s Medicaid plan accordingly (i.e., Fee-For-Service Medicaid or the Medicaid Managed Care plan. Please note, if the Member has MVP Medicaid, the claim will automatically be submitted to that plan.) Unless an exception applies, Participating Providers are prohibited from balance billing DualAccess Members.

To identify DualAccess Members, look for MVP DualAccess or MVP DualAccess Complete in the upper right corner of the MVP Member ID card. 

Providers can also check eligibility by signing into their Provider Online Account.