• Welcome to
    Health PAS-OnLine
    Medicaid is a State and Federally funded Program for eligible individuals and families
  • Welcome to
    Health PAS-OnLine
    Medicaid is a State and Federally funded Program for eligible individuals and families
  • Welcome to
    Health PAS-OnLine
    Medicaid is a State and Federally funded Program for eligible individuals and families
  • Welcome to
    Health PAS-OnLine
    Medicaid is a State and Federally funded Program for eligible individuals and families
    
5/6/2020 2:26 PM

Below is an attachment from the DHHR regarding questions about COVID-19 testing whlie being uninsured.

FAQs on the Uninsured and COVID-19 Testing Coverage.pdf

4/22/2020 12:39 PM

The below link is a reference to the BMS updates and guidelines for COVID19.

 

https://dhhr.wv.gov/bms/Pages/Coronavirus-Disease-2019-(COVID-19)-Alerts-and-Updates.aspx

4/2/2020 12:29 PM

Corona Virus Updates - Revised 03/31/2020

WV MEDICAID MAX SCRIPT DAYS LIMITS CHANGED TO NINETY (90) DAYS FOR NON-CONTROLLED MAINTENANCE MEDICATIONS

Attention WV Medicaid Pharmacy Providers,

In response to the COVID-19 novel coronavirus outbreak, until further notice WV Medicaid has changed the Pharmacy POS Max Script Days limitations policy to allow up to a ninety (90) day supply of Non-Controlled maintenance medications to be dispensed with each fill. 

This change does not apply to Non-Controlled NDC?s that currently have a specific Max Script Days limit in place (e.g. 14 days for many short-term oral antibiotics). Those specific Max Rx Days limits will remain in place. 
Additionally, this change does not apply to any Controlled Substance NDC's with a DEA Schedule of II, III, IV, or V.

WV MEDICAID COVID RESPONSE: NON-INSURED PATIENTS

In response to the ongoing COVID-19 emergency, WV Medicaid has been authorized to provide Pharmacy POS coverage of a limited number of medications to NON-INSURED patients who are experiencing symptoms associated with a possible COVID-19 infection. The following medications are available under this temporary emergency benefit: *Albuterol 90 mcg inhaler *Guaifenesin *Dextromethorphan *Guaifenesin-dextromethorphan *Acetaminophen

Prescriptions written for these medications may be covered for non-insured patients by using the Medicaid ID number 24000000099.

Prescribers please include on the prescription: "Dx: For symptoms related to a possible COVID-19 infection"

NOTE: In order to cover non-insured patients using the single ID number (24000000099), all automated drug utilization review (DUR) and clinical safety edits have been turned off in our system for any claims using that single ID number. All responsibility for the safety and clinical appropriateness of these medications lies with the prescriber and the filling pharmacist. E-prescribing functionality is still available; however, the patient history will not be accurate for the Medicaid ID listed above.

UPDATE: WV MEDICAID COVERAGE OF PLAQUENIL (HYDROXYCHLOROQUINE) AND CHLOROQUINE

As of 03/27/2020, WV Medicaid has extended the Pharmacy POS coverage of Plaquenil (hydroxychloroquine) and chloroquine to allow for USE WITH A DOCUMENTED POSITIVE TEST RESULT FOR COVID-19, both for WV MEDICAID MEMBERS and NON-INSURED PATIENTS. (Use Medicaid ID number 24000000099 for non-insured patients. DUR and clinical safety edits are turned off for claims for using this single non-insured ID number).

WV Medicaid Members with established history of use of these drugs (60 days of therapy in the past 90 days) will not require Prior Authorization, but all other claims for them will require a review by the WV Medicaid Rational Drug Therapy Program (RDTP), phone number 1-800-847-3859. On-label use requires documentation of diagnosis. Off-label use for COVID-19 requires documentation of a positive test result.

Thank you for all that you are doing during this time. We will let you know of any other changes that may be needed for this situation.

3/15/2020 2:37 PM

Coronavirus - Healthcare Common Procedure Coding System (HCPCS) Update!  ?

 https://dhhr.wv.gov/bms/News/Pages/Coronavirus-Healthcare-Common-Procedure-Coding-System-(HCPCS)-Update!.aspx.

Stay up to date about COVID-19 with West Virginia Department of Health & Human Resources:  https://dhhr.wv.gov/COVID-19/Pages/default.aspx


2/5/2020 1:02 PM

2020 Spring Provider Workshop  ?

Please join us at the 2020 Spring Provider Workshops so you and your staff will be aware of upcoming developments which may impact your practice/organization. The West Virginia Bureau for Medical Services (BMS), the West Virginia Children's Health Insurance Program (WVCHIP), and DXC Technology will be conducting eight workshops throughout the state from March 30 through April 9, 2020.  The agenda items will impact a wide variety of providers and topics.  Please take a moment to register for the workshop of your choice.   Please register using the link below or email one of our Provider Field Representatives at WVProviderFieldRepresentative@molinahealthcare.com

Registration Link:  https://www.surveymonkey.com/r/2020SpringProviderWorkshops

1/27/2020 1:05 PM

?Effective March 1, 2020 - WV Medicaid will transition how we provide health care for foster children, children adopted from foster care, children in kinship care and children diagnosed with serious emotional disorder (SED). 

In order for the below MHP Provider Letter link to work, you must be signed in first. Once logged in, click the link to see the full letter from BMS explaining the details of this upcoming change.

MHP Provider Letter

7/29/2019 9:31 AM

WV Health PAS-OnLine Upgrade may require a Browser Update

The WV Health PAS-OnLine web portal will be upgraded this evening Monday, July 29, 2019 after 7:00 PM ET. Your web browser may need to be upgraded to remain compatible with the Health PAS-OnLine web portal. After the upgrade, only the following browsers will be able to access the web portal. If you have an older browser, you may upgrade by accessing one of the links below:

If you have questions concerning the web portal upgrade or browser requirements, please contact the EDI Helpdesk at (888) 483-0793.

7/18/2019 12:17 PM

New LTC Reports are available.  Click the hyperlink for more information.

6/27/2019 11:22 AM

?New look for Electronic Health Record

Effective July 1, 2019 the Electronic Health Record functionality known as Care Evolution will no longer be available. The Electronic Health Record tool will utilize a new clinical profile functionality. Clinical Profile provides authorized healthcare providers access to a member's claims and clinical data grouped by relative types (office visits, service history, diagnosis, hospital, transportation, etc.). A new WV Medicaid TPA ? Electronic Health Record User Guide is available to provide assistance with navigating the new Electronic Health Record clinical profile functionality.

6/20/2019 5:47 PM

?The Service Coverage Limitations feature of the Member Eligibility Verification tool is INCORRECTLY returning a value of 'SERVICE NOT COVERED' for ALL service codes regardless if the service is covered or not. Please refrain from validating a member's eligibility for a particular procedure code or service code via the web portal until further notice. A new notification will be posted once the feature is displaying correctly. Contact our Customer Support Representatives at 888-483-0793 to verify a member's service coverage limitations. Note, all other eligibility information such as the member's Enrollments, Other Insurance, Copay, etc. is displaying correctly. We apologize for any inconvenience.  

6/6/2019 2:44 PM

?The Health PAS-OnLine web portal will receive enhancements during the scheduled maintenance window on Saturday June 8, 2019. The new feature available is the 'View Enrolled Providers' option located under the Account Maintenance tab. This feature allows trading partners to view enrollment information for providers and facilities associated to their trading partner account.  Click the document below to view more information on this new feature and other enhancements.

Health PAS-OnLine Enhancements.pdf

Contact the EDI Helpdesk by phone: 888-483-0793 or email: edihelpdesk@molinahealthcare.com for assistance with the enhancements.

5/24/2019 10:23 AM

Receiver ID/Sender ID Changes

DXC has updated the Receiver ID format for EDI inbound files and the Sender ID format for EDI outbound files.The previous format WV_MMIS_4MOLINA is now WV_MMIS_4_DXCMS. EDI inbound files received with WV_MMIS_4MOLINA will continue to be accepted and processed. ALL outbound acknowledgment and response files (TA1, 999, 824, 271, etc.) will be transmitted with the new Sender ID WV_MMIS_4_DXCMS in the file name and body of the file.

Updated Companion Guides with additional information and examples have been posted on the Health PAS-OnLine web portal under Reference Material. For assistance concerning this change please contact the DXC EDI Helpdesk at 888-483-0793 or email edihelpdesk@molinahealthcare.com.

5/6/2019 1:32 PM

?ATTENTION Long Term Care (LTC) Providers, Nursing Home Hospice Providers and their Billing Agencies - UPDATE

New contract rates for LTC claims have been loaded to the claims processing system.  Claims pended for rates have been adjudicated.

5/3/2019 12:35 PM

?The 2019 Spring Provider Workshop Presentations are now available. Click the above hyperlink to access the documents.

4/29/2019 10:43 AM

Paper Claim Billing - UPDATED

Effective April 15, 2019, the West Virginia Medicaid and WVCHIP claims processing system will only accept original CMS-1500 and UB 04 claim forms when billing a paper claim. This policy does not impact paper Dental ADA Forms, paper Pharmacy Universal Claim Forms or electronic claim submissions. ?CMS-1500 and UB 04 claims must be in the red ink format, copies will be returned to the provider.

3/11/2019 3:33 PM

EFT and Paper Check Notification

The WV Bureau for Medical Services is implementing an Electronic Fund Transfer (EFT) Initiative.  This effort is to decrease the administrative burden of generating paper checks.  If you currently receive reimbursement by paper check please set up EFT via the State Auditor's Website immediately.  New EFT forms are available on the State Auditor's Website (www.wvsao.gov).

Providers who's EFTs have been returned for incorrect account information will be placed on PAYHOLD.  The PAYHOLD will remain in effect until corrected EFT information is submitted.

1/10/2019 2:08 PM

The ?WV Medicaid Provider Newsletter for 4th Quarter 2018 is available.

1/7/2019 5:16 PM

?DXC Technology's West Virginia Medicaid Call Center is constantly striving to provide the best customer service experience for our provider community.  We would appreciate your feedback on your experience with our call center.  Please complete our Customer Satisfaction Survey by  clicking the available hyperlink. Thank you!

1/4/2019 1:56 PM

FQHC Correspondence Notice

If you are a Federally Qualified Healthcare Center and you received a correspondence dated January 2, 2019 related to reimbursement rates, please disregard, as the information is incorrect. A new, corrected correspondence will be sent in the coming days. We apologize for any inconvenience.

12/28/2018 12:28 PM
PAPER CHECK/EFT CHANGES
 

As you are aware, the State Auditor has released multiple letters to vendors encouraging them to change their payment method from check to EFT or Purchasing card.  The goal of this effort is to process payments more efficiently.  If you are a vendor that currently receives checks, we want to again encourage you to make the change to EFT.  By making the change, you will receive payments much safer, faster and should be provided with much quicker access to your funds.  Please follow the instructions on the Auditor's web site in order to do so. 

The link to the Auditor's site is https://www.wvsao.gov/ElectronicPayments/Default.  The web site includes information to assist vendors with this change.  The form to change is listed under vendor forms.  Select the form applicable to Medicaid WVCHIP Providers (Medicaid WVCHIP Direct Deposit Setup).

Effective January 2019 paper checks will be printed/distributed one day a week so it is imperative that you make this change in order to prevent delays in future payments.

Please contact the Auditor's Office if you have any issues with completion of the form.   

Thank you.

11/26/2018 11:21 AM

?Notice to all Providers:  The 1099s for Tax Year 2018 will be released before January 31, 2019.  Please verify your legal name and mailing address are correct by December 31, 2018.  This information may be viewed and updated on the Business Info tab of the Provider Enrollment Application accessed via the Health PAS-OnLine web portal.  If you have any questions or need assistance contact the Provider Enrollment department at (888) 483-0793, option 4.

11/26/2018 11:20 AM

The October 2018 nursing facility rates have been revised for facilities that had a SAV updated between 1/1/18 and 5/31/18.  Please watch for the revised rate letter.  If you have any questions, please contact Jeanne Snow at 304-558-8334 jeanne.l.snow@wv.gov or Sherry Jarvis at 304-558-0446 sherry.l.jarvis@wv.gov.?

11/26/2018 11:15 AM

DXC Technology completed the acquisition of Molina Medicaid Solutions effective Oct. 1, 2018.

For Molina Medicaid Solutions, this transaction represents an exciting opportunity to grow under new ownership. DXC Technology will work closely with Molina Medicaid Solutions to ensure daily operations will not be impacted due to this transaction.  Please continue business as usual as this transition is expected to be seamless to the provider and member community.

Soon you will begin to see changes to the Health PAS-OnLine web portal as we begin updating the company name and logo. Web portal accounts will not be affected. You will NOT need to register for a new account. Financial cycles, deadlines, claim billing processes, call center phone numbers and mailing addresses will remain the same.  Contact email addresses will be updated in the future and will be communicated to the provider community once completed.

For more information, please see the press release.

11/26/2018 11:14 AM

Providers Must Enroll to Prescribe for Medicaid Members

 

On and after October 17, 2018, West Virginia Medicaid will begin to deny all claims for prescriptions written by any prescriber not enrolled with West Virginia Medicaid.

Open the follow document for additional information:

Unenrolled Prescriber Newsletter.pdf

To prevent interruptions in Medicaid members? access to needed prescription medications, prescribers must make sure they are enrolled with West Virginia Medicaid.

For questions, please contact DXC Technology Provider Enrollment at 888-483-0793 or the DXC Technology Pharmacy Help Desk at 888-483-0801.
9/27/2018 3:25 PM

2018 Fall Provider Workshop Presentations Available

The 2018 Fall Provider Workshop presentations are now available under Reference Material > WV Provider Workshops or click the following hyper link to quickly access the presentations.   

2018 Fall Workshop Presentations

We encourage everyone to review the information to be aware of upcoming developments and changes that may impact your practice/organization.

9/26/2018 3:44 PM

Web Portal Connection Issues

Users who receive the error 'This page can't be displayed' when logging onto the web portal need to contact their Internet Service Provider (ISP) or IT department to request the following DNS mapping be added:  74.116.10.108     adfsi3.molinahealthcare.com 

As a temporary workaround to resolve the issue until ?your ISP or IT department is able to resolve the issue, the IP address can be updated on your computer's local host folder.  For more information on this process click the following hyperlink: Update Local Host.

7/31/2018 1:50 PM

?Opioid Prescription Changes

Beginning Wednesday, July 18, 2018, West Virginia Medicaid will no longer pay for prescriptions (including refills) for pain medication that contain opioids, if the person prescribing your medicine is not enrolled with West Virginia Medicaid.  WV Medicaid will not override the denial at the pharmacy, and no exceptions will be made.

This is a Federal rule and the Medicaid pharmacy program must follow it. 

Prescribers not enrolled in the West Virginia Medicaid program may contact the WV Medicaid Enrollment Department at 888-483-0793 for information on how to become an enrolled provider.

If you are in a Managed Care Organization (MCO) plan and your current prescriber is not willing to enroll with West Virginia Medicaid and/or you need help finding an enrolled provider, please contact your MCO's Help Desk and ask them to help you find an enrolled healthcare provider.  The numbers to call are listed below:

  • Aetna:  888-348-2922
  • Family Health Plan:  855-412-8001
  • The Health Plan:  888-613-8385
  • Unicare:  800-782-0095

If you are not in a managed care plan (known as Fee for Service), you can call the Molina Customer Help Desk at 888-483-0797 and ask them to help you locate an enrolled healthcare provider.

7/17/2018 1:02 PM

LTC Coverage Code Changes

Effective July 1, 2018, members eligible for Long Term Care services will have a different eligibility coverage code. Moving forward, LTC claims will be DENIED if the member is not eligible for LTC Coverage. Please verify the member's LTC eligibility on the WVMMIS portal for the date of services that you will be submitting LTC claims, prior to rendering services

Click the following hyperlink 'LTC Coverage Example' to view an example of how the LTC coverage will appear on the WVMMIS portal.

If you need assistance with eligibility verification, please contact Molina Customer Service at 1-888-483-0793.  If there are questions regarding the member's eligibility, please contact the member's caseworker at the county office. DHHR Client Services may also be reached at 1-800-642-8589.

5/6/2018 9:52 PM

?New Web Portal Features and Enhancements

New features and enhancements have been added to the Health PAS-OnLine web portal.  New features include managing Provider and Billing Agent affiliations.  Enhancements have been made to the Provider Directory and Manage Users areas.  For more information on the changes click the following hyperlink:  Health PAS-OnLine Updates

If you experience issues with web portal functionality, it may be necessary to delete browsing history, cookies and temporary internet files to allow your computer to access these new changes.  Click the following hyperlink for information on how to "Delete Browsing History".

If you need assistance with these new features please contact the EDI Helpdesk by calling 888-483-0793, select option 1 to enter an NPI, then select option 6 to speak with the EDI Helpdesk or send an email to edihelpdesk@molinahealthcare.com.

3/19/2018 10:18 AM

Reminder: Effective April 1, 2017, providers billing WV Medicaid for 340B outpatient drugs should submit modifier UD with the HCPCS drug code to identify drugs purchased at 340B prices.  Medicaid is required to exempt these drug claims from drug rebate invoicing.  Submission of the modifier UD will be used to identify administration of 340B drugs at the claim level.

PreviousPrevious1 - 30NextNext

 Welcome

Welcome to Health PAS-OnLine, West Virginia Medicaid and CHIP’s web portal for Members and Providers.

Home Doctor image

This website provides information to West Virginia Medicaid members, providers, trading partners and the public. Users may find helpful website links and documents within our public portal from the menu bar above. Providers and Members are encouraged to click on the appropriate tab above and log into our secure site for individual claims review, enrollment, reports and other helpful tools and information.
WV Provider Field Representative Map
5/28/2020 9:55 AM
Updated TeleHealth Questions and Repsonses
5/21/2020 12:44 PM
Telehealth Webinar Follow-Up
5/8/2020 2:28 PM
TeleHealth Webinar Questions and Response regarding COVID-19
5/6/2020 11:01 AM
HCPC 0047U Billing Update
4/30/2020 11:34 AM
PreviousPrevious1 - 5NextNext

 Member

Login to the Member Secure Portal to view your
  • Medicaid claims and notifications
  • Medicaid programs and benefits
  • Directory of Providers

 Providers / Trading Partners

Login to the Provider Secure Portal to
  • View Medicaid eligibility and history
  • Submit claims
  • Submit referrals or authorization requests
  • Check document status
  • Resume Provider Enrollment Application
  • Check Provider Enrollment Application Status

 Drug Manufacturers

Login to the Drug Manufacturer Portal

Member Responsibilities

The responsibilities of Medicaid members include, but are not limited to, the following:

  • Notifying providers in a timely manner if unable to keep an appointment.
  • Notifying providers promptly of changes in Medicaid coverage.
  • Notifying providers of any changes in other insurance coverage, such as Medicare or private health insurance.
  • Presenting a valid Medicaid identification card at each visit.
  • Forwarding money or denials received from other insurance payers to their Medicaid providers.
  • Informing their local WV DHHR office of any changes in address, income, etc.
  • Paying providers required co-pays, if applicable.

Member Liability

A provider must accept Medicaid payment as payment in full for covered services. A claim is considered paid in full even when the actual Medicaid payment is zero dollars. Providers are prohibited from imposing any additional charges on the member above the Medicaid allowable reimbursement amount. This does not include Medicaid co-payments, if applicable.

Medicaid members must not be billed, or otherwise held responsible, for:
  • Payments denied for provider error. For example:
    • Claims filed more than one year after date of services
    • Wrongful billing or missing information
  • Billings denied because the provider did not:
    • Follow procedures
    • Obtain prior approval from Medicaid or the managed care provider, if applicable.
    • Notify the member before the service is provided that is not covered by Medicaid.
  • Charges remaining after payments by insurance or Medicaid are made.
  • Fees for missed appointments

Member Responsibilities for Certain Changes

Prior to services being rendered by a provider, the provider must inform or give notice to the member that the provider will not bill Medicaid for the services and the member will be responsible for the charges. Medicaid members, if given prior notice, may be billed for:

  • Services received after Medicaid benefits are exhausted
  • Services not medically necessary that the member elected to receive
  • Services not covered by Medicaid that the member elected to receive
  • Non-emergent services not prior-approved, if applicable
  • Convenience items not required for medical care
  • Services rendered when the member is not eligible
  • Services provided when the member refuses to use other available insurance. The exception to this is the non-methadone medication assisted treatment.

Medicaid Card Information


If you are also enrolled in Managed Care, you will receive a card from that plan, as well. 
  • Medicaid Member Card:  When you qualify as a Medicaid Member, you get a Medicaid card.
  • Only you can use your card.  It is against the law to let anyone else use it.
  • Important Information about your card.   Please be sure to keep it in a safe place so you will have it when you need it. If you lose your card, you may ask for another one by:
    • Calling your case worker at your local Department of Health and Human Resources (DHHR) office, or
    • Calling the DHHR Customer Service Center at 1-877-716-1212.

    If you, or someone in your household, have a medical appointment and you cannot find your Medical Card, you can get a Letter of Creditable Coverage. This letter is only good for the day it is printed. Go to www.wvmmis.com and click "Sign In" at the top of the page. Enter your username and password.  

    If you do not have internet access, your health care provider can confirm your Medicaid eligibility.

    If you have any questions, contact your case worker or the DHHR Customer Service Center at 1-877-716-1212.

You may apply for Medicaid benefits by:
  • Going to the Health Insurance Marketplace at www.Healthcare.gov.
  • Contacting the Federal Marketplace call center at 1-800-318-2596.
  • Going online to www.wvinROADS.org.
  • Visiting your county Department of Health and Human Resources office Monday through Friday 8:30 a.m. to 5:00 p.m., except on state holidays. For your convenience you may call for an appointment. A list of offices can be found at www.dhhr.wv.gov/bcf or you can call the DHHR Change Center at 1-877-716-1212.

Medicaid Member Handbook not created yet.

"Your Guide to Medicaid" and other information about your Medicaid benefits can be found in the Member section of the WV Bureau for Medical Services website at www.dhhr.wv.gov/bms.

4/2/2020 3:35 PM
COVID-19 Update for WVCHIP Members
3/20/2020 4:44 PM
Coronavirus (COVID-19) Policy Update for WVCHIP Premiums and Copayments

 Help Documents

​ Step-by-step guides are available under Reference Materials/User Guides for Trading Partner registration. Applies to new providers, billing providers, billing agents, and clearinghouses. Providers must register before or after enrollment approval; billing agents, after receiving an Enrollment Case Number from at least one associated billing provider; and clearinghouses, anytime.

Before beginning the enrollment or re-enrollment process, gather all information needed to complete an application.  A detailed description of how to complete each of the enrollment steps and a list of information to have on hand before starting the enrollment application is located in the Provider Enrollment User Guides.  Click the available  hyperlink 'Provider Enrollment User Guides' to access the appropriate guide for assistance submitting an enrollment application for review and approval to bill WV Medicaid.

To access a provider enrollment application, providers must be a registered trading partner on the Health PAS-OnLine web portal.  To register for an account click the available 'Register' hyperlink then select "Provider – Not Yet Enrolled" from the 'Register As' drop down.  Once the trading partner registration is complete, the Provider Enrollment Application (PEA) portal will be available under Account Maintenance: Provider Enrollment.  Full access to the Health PAS-OnLine web portal will be granted once the enrollment application is approved.  Additional information on completing the trading partner registration or completing the enrollment application is available in the user guides located under the Reference Material tab. 

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). 

Billing instructions are available here.

  
  
  
There are no items to show in this view of the "Event Calendar" list.
3/20/2019 3:12 PM

A new ​Provider Field Representative Region Map is available.  Please contact the Provider Field Representative group for questions or concerns related to billing, web portal training and/or to request a site visit for assistance.  Contact the group by sending an email to: WVProviderFieldRepresentative@MolinaHealthCare.com and a representative will reach out to you.

We are here to help!

12/28/2018 12:25 PM

DXC Technology's West Virginia Medicaid Call Center is constantly striving to provide the best customer service experience for our provider community.  We would appreciate your feedback on your experience with our call center.  Please complete our Customer Satisfaction Survey by  accessing the link below. Thank you!

DXC Technology Customer Satisfaction Survey

PreviousPrevious1 - 2NextNext
There are no items to show in this view of the "Keep in Mind" list.