• 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
    
6/12/2024 12:29 PM

Claim Billing Deadline Changes 

Due to Holidays

Due to the WV state holidays on Wednesday, June 19th and Thursday, June 20th the claim billing deadline will be shortened next week.  The claims billing deadline for WVCHIP will be Sunday 06/16 at 5:00 PM ET and the billing deadline for Medicaid will be Monday 06/17 at 5:00 PM ET.  Claims must be received and processed prior to the deadline to be included in the week’s payment cycle. Please contact Gainwell’s Customer Service Center at 888-483-0793 with any questions.

5/31/2024 2:51 PM

​WVCHIP Benefit Transition Update

Please read the attached document regarding the WV CHIP Benefit Transition.


5/8/2024 3:16 PM

​See the attached 2024 Spring Provider Workshop Questions and Answers.

2024 Spring Provider Workshop Questions and Answers.pdf

3/15/2024 3:00 PM

​The 2024 Virtual Spring Provider Workshop Flyer is available.

2/27/2024 9:14 AM

EFT PROJECT 

IMPORTANT - A MUST READ

The WV Bureau for Medical Services is implementing an Electronic Fund Transfer (EFT) payment initiative and will no longer be sending paper checks. 

WV Medicaid/WVCHIP Providers who are currently receiving reimbursement by a paper check will receive letters, emails, and calls as a reminder to update their EFT documentation.

Please contact Gainwell Technologies to set up your EFT immediately to continue receiving payments.  EFT Forms are available on the State Auditor's Website https://www.wvsao.gov/ElectronicPayments/#WVMedicaid.  Please select the WV Medicaid WVCHIP Direct Deposit (Setup) Form and submit this form to create your EFT.

The deadline for completing your EFT is January 1, 2024.  Your account will be placed on PAY HOLD if your EFT information is not received by this deadline.  The PAY HOLD will remain in effect until EFT information is submitted.

If you have questions, please email WVProviderEnrollment@gainwelltechnologies.com or call (888)483-0793.

11/1/2023 9:52 AM

See the attached 2023 Fall Provider Workshop Questions and Answers.2023 Fall Provider Workshop Questions and Answers.pdf




10/17/2023 6:09 PM

​See the attached Fall Provider Workshop Presentation


2023 Fall PM Full Presentation.pdf

10/16/2023 4:24 PM

See the attached Fall Provider Workshop Presentation


2023 Fall AM Full Presentation.pdf

9/27/2023 8:35 AM
340B Pharmacy Providers,
Please read the attached announcement regarding important changes to WV Medicaid 340B Pharmacy Claims processing.
These changes will be implemented effective 10/18/2023.

9/22/2023 1:47 PM

​The 2023 Virtual Fall Provider Workshop Flyer is available and registration is now open.


2023 Virtual Fall Provider Workshops Flyer.pd



10/31/2022 8:42 AM

Warn Edit for Home Health and Private Duty Nursing

Effective December 1, 2022, claims for Home Health and Private Duty Nursing services that require electronic visit verification (EVV) must include the enrolled rendering provider’s individual NPI# and must be submitted through the state's EVV vendor, HHAeXchange.
10/12/2022 1:14 PM

The 2022 Fall Provider Workshop presentations are now available on the web portal under Reference Material > Provider Workshops.  All vendor  presentations have been compressed into two pdf documents.

8/25/2022 2:19 PM

Expired Certification Pay Hold Change Notification

Attention Providers:  Providers may now be placed on pay-hold if the record contains an expired certification; please login to the portal to view and update credentials as needed.  

8/22/2022 1:04 PM

Ambulance billing for A0998 HF - Narcan administration, is carved out of the MCOs and should be billed directly to Gainwell regardless of members enrollment with an MCO.  Any claims that have been billed to the MCOs and denied should be rebilled to Gainwell for processing and payment.

8/19/2022 1:53 PM

Providers: Payment Error Rate Measurement (PERM) Review - Reminder to Submit Medical Records

The Centers for Medicare & Medicaid Services (CMS) Payment Error Rate Measurement (PERM) Program for Reporting Year (RY) 2023 is currently reviewing the West Virginia Medicaid and West Virginia Children's Health Insurance Program (WVCHIP) to measure improper payments in order to maintain the integrity of the Medicaid program. The Review Contractor, Empower AI, is authorized to collect information from providers and to review documentation to ascertain adherence to Medicaid regulations.

Empower AI may require additional documentation and/or clarification of medical records to complete the desk audit review. To facilitate this desk audit review, West Virginia Medicaid and WVCHIP appreciate your cooperation in providing the documentation within the allotted time to Empower AI. This documentation is necessary to verify compliance with Federal and State regulations. Due to the extent of the PERM review, West Virginia Medicaid and WVCHIP ask for timeliness of submissions to aid in expediting the PERM review process.

Failure to return documentation by the due date will result in West Virginia Medicaid or WVCHIP recovering the payments by either the provider refunding the amounts or recouping the amounts from future payments.  A pay-hold will be placed on the provider until the amounts are recovered. If you are unable to provide the requested documentation, please respond to Empower AI in writing within the time allotted. Should you require additional information or have questions you may call CMS' Review Contractor's Customer Service Representatives at (800) 393-3068, for West Virginia Medicaid, your state PERM representative, Lisa Landers at Lisa.K.Landers@wv.gov or 304-558-1700 or for WVCHIP, you may contact Paula Atkinson at Paula.M.Atkinson@wv.gov or 304-414-5965.

7/12/2022 9:49 AM

​Receiver ID/Sender ID Changes

Effective July 8, 2022, Gainwell has updated the Receiver ID format for EDI inbound files and the Sender ID for EDI outbound files.  The Reciever ID/Sender ID has been updated to WV_MES_4_MMS_IG. Gainwell will continue to accept and process all EDI inbound files received with the old Receiver ID.  ALL OUTBOUND acknowledgement and response files will be transmitted with the new Sender ID.

The Companion Guides, located under Reference Material, have been updated with the new Sender ID and Receiver ID infomation.  For assistance concerning this change please contact the Gainwell EDI Helpdesk at 888-483-0793 or edihelpdesk@gainwelltechnologies.com.

4/15/2022 5:26 PM

​The 2022 Spring Provider Workshop presentations are now available on the web portal under Reference Material > Provider Workshops. All vendor presentations have been compressed into two pdf documents.

2022 Spring AM Presentation.pdf

2022 Spring PM Presentation.pdf

11/12/2021 2:47 PM

The 2021 Fall Provider Workshop presentations are now available on the web portal under Reference Material > Provider Workshops.  All vendor  presentations have been compressed into two pdf documents.

​2021 Fall Workshop - AM Presentations

2021 Fall Workshop - PM Presentations

8/27/2021 12:11 PM
WV MEDICAID PROVIDERS: GENERIC APO-VARENICLINE WILL BE COVERED THROUGH 09/30/2021
 
Because of the current shortage of brand Chantix, WV Medicaid is authorizing pharmacy coverage of generic Apo-Varenicline, with Prior Authorization (PA) required, from now through 09/30/2021. 
PLEASE NOTE: WV Medicaid will only pay for claims for Apo-Varenicline submitted for 90 days supplies.
  
Enrolled pharmacies may dispense Apo-Varenicline for prescriptions for WV Medicaid members if there is not enough product on hand to fill a brand Chantix prescription. However, per guidance from the WV Board of Pharmacy, prescriptions for Apo-Varenicline must be written specifically for either Apo-Varenicline or generic varenicline, if this is the product that is being dispensed.
4/26/2021 1:26 PM

​2021 Spring Virtual Workshops Presentations

The 2021 Spring Virtual Workshops presentations are available below.  The AM session includes all vendors with their updates. The PM session focused on CSED and SUD programs and the enrollment of direct care workers.

Presentations:

2021 Spring AM Presentation.pdf

2021 Spring PM Presentation.pdf

3/11/2021 4:22 PM

WV MEDICAID PHARMACY POS CLAIMS FOR VIVITROL AND NALTREXONE 50 MG. TABLETS TO REQUIRE DIAGNOSIS    

 

The Centers for Medicare and Medicaid Services (CMS) has notified the State Medicaid

programs of a new requirement that medications used to treat MAT (Medication Assisted Therapy)

must be identified by diagnosis when submitted to the payer for reimbursement.

 

WV Medicaid is requesting that you begin including the member’s AUD (Alcohol Use Disorder)

and OUD (Opioid Use Disorder) diagnosis code(s) on prescriptions for Vivitrol and Naltrexone 50 mg. tablets as soon as possible.

The diagnosis code(s) must be for the indication(s) for which the drug is being used.

3/2/2021 6:04 PM

​In response to the ongoing COVID-19 emergency, WV Providers may submit a claim by paper, electronically and/or by directly keying the claim (DDE) on the web portal for the reimbursement for COVID-19 testing for Uninsured and Private Insured patients.  Additional information is available in the below document and in the updated Companion Guides.  Please contact a Gainwell Technologies customer service representative at (888) 483-0793 for assistance.

WV COVID-19 Uninsured and Priviate Insured Patient Billing Options.pdf



11/30/2020 4:20 PM

Waiver Agencies Healthcare Providers Enrollment​

West Virginia Medicaid has extended enrollment to healthcare providers who are now enrolling through Waiver Agencies.  A document explaining how agencies enter the data needed to enroll providers is available under Reference Material > Forms.  Please review the Waiver Agency Template User Manual and the Bulk Upload Template to assist with the bulk upload process.

11/16/2020 8:46 AM

​The Health PAS-OnLine web portal received security updates over the weekend. The security questions for new user activation, password reset from the login page and Step 3 of the Trading Partner registration process have been updated from freeform question and answer fields to a more secure predetermined question list with a freeform answer field. Review the attached document for more information.

New Health PAS-OnLine Security Updates.pdf

 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.
2024 ABH Provider Workshop
6/18/2024 1:26 PM
Claims Webinar for June 2024
5/21/2024 9:37 AM
Enrollment Webinar for June 2024
5/21/2024 9:35 AM
Guideline Checklist for A0998 Treat-No-Transport
4/26/2024 3:00 PM
Claims Webinar for May 2024
4/26/2024 2:47 PM
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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 atwww.Healthcare.gov.
  • Contacting the Federal Marketplace call center at 1-800-318-2596.
  • Going online to https://wvpath.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 https://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 Members section of the WV Bureau for Medical Services website at www.dhhr.wv.gov/bms.

5/31/2024 7:31 AM
Attention Members- regarding pharmacy benefits, please review the attached document.
5/17/2023 3:22 PM
WVCHIP Member Copayments Update

 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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1/12/2024 1:55 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@gainwelltechnologies.com and a representative will reach out to you.

We are here to help!

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