• 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
    
5/8/2019 2:15 PM

Receiver ID/Sender ID Changes-Updated

Effective May 21, 2019, DXC will be changing the Receiver ID format for EDI inbound files and the Sender ID format for EDI outbound files. The current format WV_MMIS_4MOLINA will be changed to WV_MMIS_4_DXCMS.  EDI inbound files received, after the effective date, with WV_MMIS_4Molina will continue to be accepted and processed with ALL outbound acknowledgment and response files (TA1, 999, 824, 271, etc.) being transmitted with the new Sender ID (WV_MMIS_4_DXCMS) in the file name and body.

Updated Companion Guides with additional information and examples will be released to the Health PAS-OnLine web portal.  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.

 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.
Billing Updates for CPT Code 81528
5/2/2019 1:33 PM
Billing Updates for WVCHIP Physical & Occupational Therapist
4/3/2019 1:01 PM
LARC Billing
3/25/2019 10:48 AM
Billing Updates for CPT Code 81479
3/21/2019 10:13 AM
Billing Updates for CPT Code 81541
3/21/2019 9:59 AM
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 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.

11/29/2018 5:36 PM
WV CHIP Premium Invoice Notification

 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.

  
  
  
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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

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