• 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
    
8/2/2018 10:45 AM

2018 Fall Provider Workshops

​Please join us at the 2018 Fall Provider Workshops so that you and your staff will be aware of upcoming developments which may impact your practice/organization. Eight workshops consisting of two separate sessions will be conducted throughout the state from September 10th - 20th, 2018. Identical workshops are offered at each location to accommodate as many providers as possible.

Click the following hyperlink: 2018 Fall Provider Workshops for more information on the two separate sessions, presenters and locations.  *CEU’s may be available for hours attended*

Registration Link: https://www.surveymonkey.com/r/2018FallProviderWorkshop

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.

5/21/2018 2:13 PM

​The 2018 Spring Provider Workshop presentations are now available on the web portal under Reference Material - WV Provider Workshops or click the available hyperlink '2018 Spring Workshop Presentations' to quickly access the documents.

5/11/2018 5:38 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.

 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.
SUD Survey Link
8/17/2018 3:52 PM
2018 Flu Vaccine Update
8/14/2018 10:22 AM
Provider Enrollment Application Update
7/26/2018 9:52 AM
​LTC Coverage Code Changes
7/17/2018 1:39 PM
NEMT Vendor Notification
7/12/2018 1:01 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 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 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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2/21/2018 12:22 PM

A new ​Provider Field Representative Region Map is available.  Currently our Provider Field Representative assignments are being restructured with the addition of new staff.  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!

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). 

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