Before beginning enrollment or re-enrollment, prepare information needed by accessing the Provider Enrollment Checklist that gives all required steps in order to submit an application for review and approval to bill WV Medicaid.Provider enrollment/revalidation has begun. This process will be conducted in a phased-in approach. Phase I began on June 3 and includes only direct individual physicians, direct chiropractors, direct podiatrists and direct optometrists. Please note: Only the provider types identified for Phase I may revalidate via the portal at this time. A planned schedule of phases will be posted on the web portal to outline each provider type and their enrollment/revalidation time period. If you have any questions, please contact the Provider Enrollment Unit at (888) 483-0793, option 3, Monday through Friday, between the hours of 8:00 am and 5:00 pm (EST).
Begin the provider enrollment process, choose one of the following:
You must first complete the provider enrollment process before registering as a trading partner.
Molina is offering open webinars to further assist providers with their enrollment/revalidation process on the Provider Enrollment Application Portal. In these sessions, a provider enrollment specialist/trainer is available to discuss common issues and answer questions regarding the enrollment/revalidation process.For your convenience, two reoccurring time slots are available. An evening session will be held every other Wednesday at 4:00PM EST and a morning session will be held every other Friday at 9:00AM EST. The sessions will be scheduled for 2 hours.
Following our Fall 2014 Provider Workshops we will be resuming back to the normal Webinar schedule.
The sessions will continue for the remainder of the enrollment/revalidation time period. Please note there will not be a webinar the last week of October due to the Provider Workshops.
Pursuant to Section 1128 and Section 1902(a)(39) of the Social Security Act, the West Virginia Medicaid Program will not reimburse a provider for any services or items that were rendered or ordered/prescribed by a sanctioned (e.g., suspended, excluded) provider. The effect of the provider's sanction precludes them from furnishing, ordering, or prescribing services or items to a Medicaid member. Claims for services/items rendered/ordered/prescribed by a sanctioned provider with dates of service or dispensing after the effective date of the sanction, will be rejected or disallowed if discovered during a post-payment review.In accordance with the Patient Protection and Affordable Care Act (Pub. L. 111-148, enacted on March 23, 2010, as revised by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), enacted on March 30, 2010, together known as the Affordable Care Act (ACA), the West Virginia Medicaid Program is required to terminate enrollment of any provider that is excluded under Medicare or any other state Medicaid Agency. Excluded individuals and entities prohibited from participating in the West Virginia Medicaid Program are identified in the following list. Excluded individuals and entities are listed according to the type of provider they were at the time of exclusion; however, they are excluded from participating in providing services in the Medicaid program in all categories of services and in any capacity. The exclusion remains in effect until they are removed from this list.Any provider participating or applying to participate in the West Virginia Medicaid program must search this list and the Federal Office of Inspector General's List of Excluded Individuals and Entities (LEIE) at http://oig.hhs.gov/fraud/exclusions.asp on an annual basis to determine if any existing employee, contractor, owner or board member has been excluded from participation in the Medicaid program. Also, any provider participating or applying to participate in the West Virginia Medicaid program must search both lists prior to hiring staff to ensure that any potential employees, contractors, owners or board members have not been excluded from participating in the Medicaid program.
Click Here for WV Medicaid Sanctioned/Excluded Provider Listings.
Health care providers, who, under the State Plan and/or State statute are required to be licensed in West Virginia (WV) or the state in which they practice, must maintain and ensure that a current license is on file at all times with West Virginia Bureau for Medical Services (BMS) Provider Enrollment Unit, Molina. A provider's participation in the WV Medicaid Program may be terminated if Molina cannot verify the current status of a provider's license.
Click Here for the revised license policy.