PVP MHP Billing Form 2026

  • Physician Vitality Program Contract Billing and Demographics Submission (v2026)

    Submit a separate bill for each individual client for each month on this form. Do not submit any client names on this form. If the combination of the client's age, gender, specialty, employment status and credentials is so specific, it could compromise their identity, choose other/unreported on one of those indicators to mask them fully. If you have trouble with the form, text or call (415) PVP-ACMS (415-787-2267) or call 208-336-2930.
  • Are you billing for*
  • Billing Submission Date
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  • Billing Period Ends*
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  • It looks like there is more than six months between the Billing Period End {BillingPeriodEndDate} and today. ACMS requests billing be completed in a timely manner each month. 

    • Please verify your Billing Period End date for accuracy. If it truly is within the last calendar year, you may proceed. If it is prior to the contract year, you may not bill for this appointment.

  • Eligibility

  • Slow down. Did you really mean IDAHO county? If so, proceed, but unless you're serving somebody from Grangeville, Kamiah, or Kooskia, you probably mean a different county.

  • You have marked both IMA and IAFP as NO for eligibility. There are two more less frequent options:

    1) Does the client show as an ACMS Pending member in the eligibility lookup tool due to large group employment?

    Pending ACMS members are those whose membership is paid for by a group practice or hospital system employer. Some membership benefits are advanced before membership is fully paid.

    ACMS members with a "pending" status may access PVP Psychotherapy Services, but not Vitality Coaching services.

    You must confirm eligibility using the regular verification tool.

    2) Does the physician represent themselves as an insured member of MIEC, a medical liability insurance company?

    • Physicians with a current MIEC insurance policy are eligible.
    • Associated ancillary medical or non-medical staff are not eligible.
    • You do not need to ask the physician making the appointment to show a Certificate of Insurance from MIEC. You may proceed based on their assertion of MIEC insured member status. 

  • Since you have marked both IMA and IAFP as NO for eligibility and the Ada/Elmore county client does not show up as an ACMS Pending member they are ineligible for services. Please email the director or call 208-336-2930 for guidance.

  • Coaches:

    Something is wrong. You need the combination of the following in order to move forward on billing for this client:

    • County = Ada or Elmore
    • IMA Member Eligibility = Yes
    • ACMS Member Eligibility = Yes

    Any other combination does not qualify for PVP Coaching Services.

    • Eligibility Verification Instructions 
      • You must confirm membership eligibility for
        • Every new client at the time of scheduling their first appointment
        • Upon scheduling their first appointment upon renewal of a 12‑month benefit period
        • Upon scheduling the first appointment following March 31 of each year (end of membership dues grace period) to confirm they remained a member
      • Determine eligibility based on who the client says they learned about the program from - this will determine which membership association will be billed. Please stay consistent between billings on any one client.
      • Client members who may be eligible under more than one medical society/association may still have the same maximum allotment of 5.0 appointment hours per year (booked in 1/2 hour increments), regardless of dual or triple eligibility.

    • PVP Psychotherapy Services

      Idaho Medical Association

      All medically licensed members of IMA, plus retirees who no longer hold a license


      IAFP - Idaho Academy of Family Physicians
      All licensable members of IAFP are eligible, including attending physicians and medical residents, as well as retirees.

      Medical Insurance Exchange of California (MIEC)

      • Member physicians with a current MIEC insurance policy are eligible.
      • Associated ancillary medical or non-medical staff are not eligible.

      What about medical students?

      ​Medical students based in Idaho do not normally qualify for PVP and they should seek care through their school provided/contracted counselor. However, in an urgent or critical case they make seek help through PVP.

      What if I can't verify membership?

      If a new client insists they are a member of one of the above associations, but cannot be verified this route, please see them if the issue is urgent. Before the next appointment, however, please call the ACMS office to find how to best verify their membership while maintaining confidentiality.

      There may be alternate ways to verify this while maintaining their confidentiality, their membership may have lapsed, they may be confused about membership coverage.

    • PVP Coaching Services

      Ada County Medical Society Members Only
      All medically licensed members of ACMS whose primary workplace (or corporate headquarters) is Ada or Elmore County.

      What if I can't verify membership?

      PVP Coaches may not proceed with coaching until ACMS membership can be verified. Please reach out to the ACMS office to find how to best verify their membership while maintaining confidentiality.

      What about medical students?

      ​Medical students based in Idaho do not normally qualify for PVP and they should seek care through their school provided/contracted counselor. However, in an urgent or critical case they make seek help through PVP.

  • Appointments

    • First-Time Appointment of the Benefit Year 
    • "First Time Appointment" of the Benefit Year*

    • Mark an appointment as the First Appointment of the Benefit Year if any of the following are true:

      • The client is starting a new 12‑month benefit year.
      • The appointment is a Meet and Greet or Introductory appointment.
      • The client has never used PVP services before.

      Do NOT mark this as a first appointment if you learn that the client has already seen another PVP provider in an existing 12‑month benefit year. You will need to ask the client about prior PVP use to determine this. 

      PVP Coaches, you may be doing a Meet and Greet/Introductory appointment with a medical resident who has already seen a PVP MHP in the past year. if this is the case, mark this field as No.

    • What is the client's First Time Appointment date in the 12-month benefit year?*
       - -

    • It looks like there is more than a year between the Billing Period End {BillingPeriodEndDate} and the Benefit Year starting date {BenefitYearStart}. No more than 13 months could possibly separate these.

      • Please verify your Billing Period End date for accuracy.
      • If one year has passed since the date reporting you are reporting as the start of current benefit year, then you should be starting a new one.

       

    • You stated you are billing for a first-time appointment. But you are also saying the First Time Appointment of {BenefitYearStart} is at least a month different than the Billing Period End date of {BillingPeriodEndDate}. These must be within the same month even if more than a month has passed since the billing submission date. 

      • Please verify your Benefit Year Start and Billing Period End dates. 
    • Intake Paperwork 
    • Are you billing $25 for INTAKE paperwork with this client for YOUR very first time this month? (click expand to see definition below)*


    • It looks like you are trying to bill for intake paperwork this month when you've only reported a Meet and Greet. Even if the client completed paperwork, you       may only bill for intake paperwork in the month of their first full clinical or coaching appointment with you.

       

    • Intake Appointment Definition 

    • Intake Appointment Definition

      An Intake Appointment is usually, but not always, a first‑time appointment. It allows an additional $25 reimbursement for completing your initial Consent to Treat or coaching agreements with this client.

      Mark YES if you are meeting with a client for the first time and are establishing care, including when:

      a) The client has not used PVP services before, or
      b) The client has used PVP services previously with a different PVP provider.
      c) It has been at least three years since you last saw the client.

      Do NOT mark YES

      a) Solely because you are renewing consent forms or updating demographics at the start of a new benefit year.
      b) If you are ONLY billing for a Meet and Greet appointment (pre-clinical) this month. If the client returns for their first clinical appointment, then bill for client intake paperwork in that month.

    • Billing Hours 

    • Mark 1 to bill a a no-show or late cancellation without adequate notice. Each no- show reported and paid for counts as 30 minutes against the member’s covered sessions for the benefit year. Meet and Greet no-shows are NOT billable.

    • Prior PVP Use in the same Benefit Year

      PRIOR to this billing month, how many PVP billed hours had THIS client utilized during the current 12-month benefit period?

      • DO report any other hours in the benefit year that you have provided
      • DO report any other hours in the benefit year that you are aware another PVP MHP or Coach has provided
      • DO report any no-shows in the Benefit Year that you or another PVP MHP or Coach has billed for
      • DO NOT report any Meet & Greet hours . They are outside of the five-hour benefit limit. (If this MHP client started with Meet and Greet hours in 2025, disregard them even if previously reported to ACMS.)
      • PVP Coaches - do not report any pilot year hours from 2025

    • It looks like the total hours you are billing for this month ({TotalHoursBilled}) plus any prior appointments in the client's "Benefit Year" ({priorTo}) will push them over the number of hours allowed.

      Please make the appropriate changes before proceeding.

      Emergency Overage Billings

      Under certain circumstances, PVP will allow for additional billings beyond the limit of five (5):

      • They are having a mental health crisis. Additional appointments directly related to the crisis are allowed, but not to exceed 8 total for the benefit year.
      • They have completed five sessions but could really benefit from one more. One more would be allowed.

      Please call or email the director to 208-336-2930 if there are other reasons that may indicate a need for overage appointments.

  • Unique Client ID

  • This form generates a random four-character unique ID for your client. You will use this ID for all future billings for the same client. This allows us to track billing activity over time within a single benefit year, albeit not across different PVP providers.

    If this is the first billing for this client in the current benefit year, record the unique ID generated on the client’s paperwork. Use this ID for all future billings for the client until the benefit year resets.

    If this is not your first billing for this client in the current Benefit Year and you have not yet received a unique client ID, click Generate ID below.

  • This form generates a random four-character unique ID for your client. You will use this ID for all future billings for the same client. This allows us to track billing activity over time within a single benefit year, albeit not across different PVP providers.

    Since this is not your first billing for this client for this benefit year but it might be the first time you've seen this function, select one choice below. 

  • Click one only*

  • Please record this ID on your client's paper record and use it the next time you submit a bill for the same.

    • Client Demographics 

    • It looks like you are trying to bill for a Resident meet and greet but are marking the member type as other than Resident.

      Please make the appropriate changes before proceeding.

    • I noticed you marked a non-resident as employed by a Residency Program. Please report as follows:

      • Non-resident employed by Full Circle Health or other residency program - report as Large Group
      • Non-resident employed by UW Psych or Internal Medicine Residency - report as Government (Boise VAMC)
      • Non-resident employed by EIRMC/Kootenai Health - report as Hospital System Employed

      Although these others work for a residency program, typically as faculty, we do not mark them as EMPLOYED by the residency program but rather by the "clinic/institution" they work for.

      Please make the appropriate changes before proceeding.

    • Who should the authorized overcharge be billed to*

  • Billing Summary and Submission

    Fields below are calculated based on previous answers. If you feel they are not correct or need to be edited, please go back to the appointments section to edit accordingly.

  • By signing and submitting below I certify that the appointments are billed in agreement with my contract with Ada County Medical Society, that qualifying membership was verified prior to initial appointments and the first appointment after April 1 of each year.

    Contractors will bill the ACMS on a monthly basis for all counseling sessions provided during a calendar month within 15 days. Payments will be made within thirty (30) days of the ACMS’s receipt of invoice for each calendar month of the Agreement Term. All monthly demographics must add up appropriately before processing for payment.

    A confirmation email will be sent to you upon successful submission.

    Please call Steve Reames at 208-336-2930 should you have any questions

  • Based on the hours reported for this client for the current benefit year, please be sure to remind them to fill out an evaluation of the program at this link. You can also provide this to clients who are finishing with you even if they use less than the maximum number of appointments.

    https://form.jotform.com/213464794079063

    A printable version is available here

  • Paid Date
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  • Subcontract Billed
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  • Reload

  • ARCHIVAL DATA FIELD CONTAINERS FOR PREVIOUS FORM ITERATION VALUES

  • Eligibility (Archival)
  • Should be Empty: