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Provider Enrollment

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 included 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 7:00 am and 7:00 pm (EST).  

Begin the provider enrollment process, choose one of the following:

  • For new enrollments, please contact Gainwell Technologies Provider Enrollment
  • Revalidate
  • Resume

You must first complete the provider enrollment process before registering as a trading partner.



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The below document provides details on the WV Provider Enrollment license and certification lapse policy.  Contact the Gainwell Technologies Provider Enrollment Department at 1-888-483-0793 if you have any questions.

WV Provider Enrollment License Certification Lapse Policy.pdf

 

  

Limited Maintenance is now available on the Provider Enrollment Application (PEA) portal.  This new feature will save time for providers, particularly large groups, by limiting the amount of provider data retrieved for specific maintenance activities.  Limited maintenance will allow both the addition and removal of Service Locations and Rendering or Ordering/Referring/Prescribing Providers for currently enrolled/active providers with WV Medicaid and WVCHIP.  Supporting documentation is required, with ALL original signatures, and must be submitted through U.S. mail to:  

Gainwell Technologies

Attn: Provider Enrollment Department

P.O. Box 625

Charleston, WV 25322-0625

If you have any questions, please call Gainwell Technologies Provider Enrollment team at 1-888-483-0793, and select option 3.  

  
In this document contains a number of Frequently Asked Questions relating to the Provider Enrollment Portal Application. 
 
WV Provider Enrollment and Revalidation General FAQ.pdf
  

Effective 03/14/2016, the Ordering/Referring/Prescribing (ORP) provider that is submitted on all WV Medicaid and WV CHIP claims MUST have an active enrollment with WV Medicaid.  Claims will DENY if the ORP is not actively enrolled with WV Medicaid.

Access the ORP Provider Validation dropdown on the Provider Directoy tab of the WVMMIS web portal to conduct a provider search.

  

Effective July 17, 2017, MCO-only providers may enroll on the Provider Enrollment Application (PEA) portal. There are links available on the portal for in-state and out-of-state providers. For assistance with your application, please contact the Gainwell Technologies Provider Enrollment department at 1-888-483-0793. 

Once your enrollment application has been submitted through the Gainwell Tehcnologies PEA Portal, a letter will be mailed to the Pay To provider’s mailing address if any correction or missing documentation is required. Providers will then have 60 days from submission of the application to submit corrections or missing documents to the Gainwell Technologies Provider Enrollment department. All signature pages from the application must be mailed to Gainwell Technologies, signed in BLUE ink. Upon completion of your enrollment, each Pay To provider will receive a welcome letter from Gainwell Technologies and the MCO will be notified.

Providers will have 120 days from the date of enrollment to complete their enrollment application via the Gainwell Technologies PEA portal. MCO providers who are already enrolled with WV Medicaid do not need to submit a separate enrollment application.