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| 5/10/2023 7:40 AM | |
Missing 835 Update Gainwell is in the process of releasing all missing 835s HOWEVER please be advised there maybe a balancing issue within the 835 file. The balancing issue affects claims with primary COB information submitted at the header level resulting in the CAS*OA*23 and/or CAS*CO*45 segment(s) of the 835 to be missing or incorrect therefore the adjustment amounts do not balance. The claim billed amount and the claim paid amounts are correct. The team is working on a resolution however there is no ETA at this time. More information will be provided once the issue is resolved. Please reach out to the EDI Helpdesk at edihelpdesk@gainwelltechnologies.com with any questions or concerns. We apologize for the inconvenience.
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| 2/23/2023 12:58 PM | | The WVMMIS site upgrade is complete. It may be necessary to clear your browsing history, cookies, and cache to resolve any slowness or formatting issues. You should also replace any saved links or shortcuts to our site. You can delete the current shortcut and then type in our address and resave it.
Contact the EDI Helpdesk at edihelpdesk@gainwelltechnologies.com for further assistance. |
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| 2/15/2023 9:56 AM | | The WVMMIS site will be unavailable for scheduled maintenance and upgrades during the weekend of 02/18/2023 where the portal will be unavailable from 02/18/2023 starting at 7:00 a.m. EST until Noon EST on Monday 02/20/2023. Thank you for cooperation and we apologize in advance for any inconvenience. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 7/1/2022 11:26 AM | | Transactions Not Displaying Under File Exchange - Update Gainwell Technologies is aware that electronic transactions uploaded between 06/25/2022 12:00 AM ET and 06/27/2022 4:22 PM ET did not display on the WVMMIS web portal under the File Exchange tabs. Please be advised the transactions were received and valid claims did generate in the claims processing system. Resubmitting these files will create duplicate claims. UPDATE - The team has released the missing files and response files to the web portal however to complete this, without causing duplicate claims, the files were generated in the test environment therefore the ISA15 has the 'T' indicator, and the web portal displays them as a 'T' test file. It may be necessary to download the response file and update the test indicator to a 'P' before running the file in your system. Please contact the EDI Helpdesk with any questions or concerns. We apologize for any inconvenience. EDI Helpdesk: edihelpdesk@gainwelltechnologies.com |
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| 4/8/2022 10:20 PM | | WVMMIS updated part of its SSO domain on April 8, 2022 to: https://gw-prd-sso.slhcare.com/. Depending on network securities, some company may need to whitelist the new domain address. |
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| 3/4/2022 9:36 AM | | The View Payment Detail tab is not functioning as expected by indicating "No Payments were found". To view payment details, click the Search hyperlink located on the right. Enter the search criteria such as Payment Number or Payment From Date and Payment To Date then click the SEARCH button below. The Payment Details information will display. |
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| 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. |
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| 6/1/2021 10:34 AM | | Google Chrome and Microsoft EDGE web browser versions have been updated to Chrome: 91.04.4472.77 and EDGE: 91.0.864.37. These versions include updates that are not compatible with the Health PAS-OnLine web portal. Users are experiencing blanks screens or display error messages. It is recommended that users utilize Internet Explorer 11, Safari, Firefox, or another web browser until the Chrome/EDGE issue is resolved. Below is a document with instructions on updating IE11 privacy settings to make IE11 compatible. The following Chrome version: 90.0.4430.212 and EDGE version: 90.0.818.66 is still compatible by updating the samesite flags. Below is a document on how to update the flags.  IE11 Compatibility.pdf
Update Samesite Flags for Chrome and EDGE.pdf The team is working diligently to resolve these issues and expect
an update very soon. If you have any questions concerning this information or these instructions please contact the EDI Helpdesk at 1-888-483-0793, option 6 after entering your NPI.
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| 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 |
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| 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. |
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| 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
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| 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.
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| 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
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| 7/23/2020 10:46 AM | | The Application for COVID-19 Testing Coverage permits applicants to verbally designate a provider as an authorized representative for purposes of signing and submitting the application. You may not act as an authorized representative unless affirmatively designated by the applicant/patient. Below is the consent form to complete and submit along with the COVID-19 Testing Coverage application. Application for COVID-19 Testing Coverage.pdf
Appendix C - Consent Form.pdf
To verify the applicant's verbal consent to appoint you as an authorized representative: 1. Ensure that an authorized representative form is filled out in its entirety, 2. Review the entire document verbally while on the telephone with the patient, 3. Write the patient's name on the signature line with a notation that consent was obtained via phone due to COVID-19 precautions, 4. Document the time and date of the call on the form, and 5. Provide the authorized representative consent form with the signed application. |
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| 6/30/2020 2:25 PM | | Reminder - Copay Waiver for Medical/Dental Services Effective 03/19/2020, The West Virginia Medicaid Program will waive copays for all medical and dental services until further notice. This waiver is related to West Virginia's declared State of Emergency due to the COVID-19 pandemic. |
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| 6/9/2020 8:28 AM | | The West Virginia Medicaid program provides limited health care coverage for the testing and diagnosis of Coronavirus (COVID-19) to the uninsured. This limited coverage may also include outpatient prescription drug treatment for uninsured patients who are experiencing symptoms associated with a possible COVID-19 infection. For more information on how uninsured individuals may apply for coverage, please visit: https://dhhr.wv.gov/bms |
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| 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.
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| 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 |
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