• 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
    
7/20/2017 5:26 PM
MANAGED CARE ORGANIZATION (MCO) PROVIDER ENROLLMENT
Effective July 17, 2017, MCO-only providers may enroll on the Molina 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 Molina provider enrollment department at 1-888-483-0793.  Click the following hyperlink for more information: MCO Provider Enrollment
7/7/2017 2:40 PM

Attention Anesthesia Providers:

Billing Units vs Minutes
In order to be in compliance with CMS 5010 HIPAA electronic claims standards guidelines, the Bureau for Medical Services and WVCHIP policies require administration of anesthesia CPT codes beginning with ‘0’ (administered by anesthesiologists and CRNAs) to be billed in minutes when billing paper claims, electronic claims (EDI), or Direct Data Entry through Molina’s web portal (DDE).

Click the following hyperlink for more detailed information: Anesthesia Providers: Billing Units vs Minutes

6/12/2017 3:19 PM
Prescription Drug Pricing Methodology Changes

The West Virginia Medicaid Pharmacy Program will implement a change in pricing methodology as of Wednesday, June 21, 2017.  Access the Prescription Drug Pricing Methodology Changes hyperlink for additional information.
 
5/23/2017 4:26 PM
MCO Pharmacy Benefits Transitioning
to Fee for Service Program
 

As of July 1, 2017, the WV Medicaid Fee for Service Program will provide retail Point of Sale (POS) pharmacy services for all Medicaid MCO patients   Prior authorization obtained from the MCOs will be transferred to the Molina system and will be honored for the amount of time through which they were issued by the MCOs.

Medicaid members should experience no disruption in service and can continue to take their prescriptions to the pharmacy of their choice.

Drug services billed with a CPT or HCPCS code (buy-and-bill), administered by a healthcare professional, will continue to be reimbursed by the Medicaid member's individual MCO.

To obtain a prior authorization after June 30, 2017 for retail pharmacy POS services, please contact the Rational Drug Therapy Program by fax at 800-531-7787 or by phone at 800-847-3859.

Click the following hyperlink for more information: Pharmacy Notice

4/18/2017 11:20 AM

2017 Spring Provider Workshop Presentations Available

The 2017 Spring Provider Workshop presentations are available on the web portal.  Access the documents by clicking the hyperclick WV Provider Workshops 2017 or go to Reference Material - WV Provider Workshops - WV Provider Workshops 2017.

 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.

 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.

3/25/2016 5:40 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 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 7:00 am and 7:00 pm (EST). 

Billing instructions are available here.

  
  
  
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7/21/2017 4:53 PM

To access a provider enrollment application, providers must first become 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.  The Provider Enrollment Application (PEA) portal will be available under Account Maintenance: Provider Enrollment after the trading partner registration is complete.  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 or need additional assistance, contact the Provider Enrollment Unit at (888) 483-0793, option 3, or the EDI Helpdesk at (888) 483-0793, option 4, Monday through Friday, between the hours of 7:00 am and 7:00 pm (EST). 

7/7/2017 2:38 PM

A new ​Provider Field Representative Region Map is available.  Click the hyperlink to view the representative assigned to your region.  Contact your representative for questions/concerns related to billing, web portal training and/or to request a site visit for assistance. 

We are here to help!

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