Beginning january 1, 2014, wv medicaid copayment amounts for eligible members are based on the following. Texas, virginia, washington, west virginia, and wyoming cover telemedicine. West virginia family health wvfh will no longer be participating in the medicaid program with the bureau for medical services bms effective july 1, 2019. Certain medicaid waiver payments may be excludable from. Providers west virginia department of health and human. West virginia medicaid provider required provisions. The medicaid change report files contain only the changes made in the medicaid ncci edit files from the previous calendar quarter. Aug 01, 2015 medicaid eligibility report fy2017 january 10, 2017. To obtain a copy of the illinois healthcare and family services managed care manual for medicaid providers, click here. Effective january 1, 2014, the health plan began a medicare special needs plan snp for those. The electronic medicaid provider manual contains coverage, billing, and reimbursement policies for medicaid, healthy michigan plan, childrens special health care services, maternity outpatient medical services moms, and other healthcare programs administered by the michigan department of health and human services mdhhs. Your 2016 guide to medicaid d2b public outreach and notice meetings list.
Nov 04, 2019 west virginias leaders opted to expand medicaid under the aca as of january 1, 2014, and nearly 157,000 people are covered under the expanded eligibility rules. Chapter 1 welcome to aetna better health of west virginia 9. If you are in a managed care organization mco plan and your current prescriber is not willing to enroll with west virginia medicaid andor you need help finding. Please refer to the covid19 alerts and updates page for specific changes and updates. General information for providers manual montana medicaid. This manual serves as an administrative guide outlining beacons policies and procedures governing. As of july 1, 2017, pharmacy services for wv medicaid managed care organization mco members will be administered by the traditional feeforservice pharmacy program. The west virginia wv medicaid program offers a comprehensive scope of medically necessary. Hospice pertinent information survey survey deadline, november, 2017. Since our initial report in september 2014 11 states and d. Pharmacy provider manual 2 p a g e about us in an environment where plan sponsors are increasingly looking for greater transparency and accountability, navitus health solutions, llc a division of ssm health stands alone as the industry. Additional temporary extension of the spousal impoverishment rules for married applicants and recipients of home and communitybased services september 4, 2019. If you need an older version of an administrative guide or care provider manual, please contact your provider advocate. As such, current wvfh members will be transitioned to another managed care organization between may 1 and july 1.
The hospital is then settled for outpatient services at the lower of cost or charges when their cost report is audited. Medicaid updates august 2015 recording from august 3, 2015. About this provider manual this behavioral health provider policy and procedure manual hereinafter, the manual is a legal document incorporated by reference as part of each providers provider services agreement psa with beacon. Kidstrong conference school nursing medicaid presentation june 22, 2016 pdf. You may now qualify for medicaid west virginia department of. On january 3, 2014, the internal revenue service issued notice 2014 7, 2014 4 i. Pharmacy west virginia department of health and human. State of west virginia department of health andhuman.
These data replace the medicaid ncci edit files from previous calendar quarters. Provider manual cover transmittals the link provided under the manual column below is to the cover transmittal memo which explains the revisions to be made. P a g e e ga early and periodic screening, diagnosis and. The program policy was established in wv medicaid chapter 535 and utilized to establish kepros utilization guidelines. The manual contains mandatory billing forms that all leas must use.
Effective september 26, 2016, coventrycares of west virginia became known as aetna better health of west virginia, inc. The appellants trip to the same provider on october 18, 2016, was denied on march 9, 2017, because she did not go to the closest provider. Wv medicaid members, healthysense is a great resource of health and wellness information. The health plans provider manual contains comprehensive information related to best. Medicaid behavioral health provider manual the health plan. Wv medicaid services memorandum on telehealth covid19 and. Persons on the oig medicaid exclusion list cannot provide medicaid services. In order to view the actual changes you must select the provider manual link then the manual and chapter you wish to view or download. At lower income levels, families may be eligible for wv medicaid. West virginia also expanded its chip coverage in 2019 to include pregnant women. August 3, 2015 special education director webinar powerpoint.
Chapter 506 durable medical equipment, prosthetics, orthotics and supplies dmepos appendix 506a covered dme supplies effective january 1, 2018 appendix 506b covered o and p supplies updated january 1, 2016 appendix 506c noncovered dmepos supplies updated january 1, 2016. Wv medicaid encourages providers to render services via telehealth in the behavioral health clinic services program. Nd medicaid ambulance provider fee schedule 712017 nd medicaid ambulatory surgical center asc fee schedule 712017 nd medicaid dme purchase fee schedule 712017 nd medicaid dme rental fee schedule 712017 nd medicaid nonemergency transportation fee schedule 712017 nd medicaid professional services fee schedule 712017. The presence of a hcpcscpt code in a proceduretoprocedure ptp edit or a medically unlikely edits mues value for a hcpcscpt code does not necessarily indicate that. To find the contact information for your provider advocate, go to find a network contact opens in a new window, and then select your state. West virginia department of health and human resources, bureau for medical services began planning the implementation of health homes in 2011.
Nd medicaid ambulance provider fee schedule 71 2017 nd medicaid ambulatory surgical center asc fee schedule 71 2017 nd medicaid dme purchase fee schedule 71 2017 nd medicaid dme rental fee schedule 71 2017 nd medicaid nonemergency transportation fee schedule 71 2017. The payment is calculated as the costtocharge ratio times billed charges. In 2017, nearly all states and the district of columbia provided some coverage of telehealth in feeforservice. The table below shows abbreviations used in the evs coverage field and the full name of the corresponding coverage plan. Screening for medicaid funded longterm services and supports screening ltss. Screening for medicaidfunded longterm services and supports screening ltss. Provider manual west virginia department of health and human. The release notes include the sections and handbooks that have changed for the current month and the nature of the changes. This page provides links to information medicaid providers may need in order to better serve their patients andor to better understand the medicaid program.
The wv bureau for medical services bms, wv childrens health insurance program wvchip, and molina medicaid solutions will be conducting eight 8 workshops. Table of contents west virginia department of health and. Wv medicaid wvchip direct deposit change 1252018 10. This means enhanced assessment and management for enrolled members.
The west virginia medicaid program provides free or lowcost health coverage to. Policy manual west virginia department of health and human. West virginia state telehealth laws and reimbursement policies. Bms provider manual page 2 chapter 521 behavioral health outpatient services revised 1152018.
Please be advised that the west virginia medicaid provider manual does not address all the complexities. Behavioral health policy and procedure manual for providers. Information on these files is contained in change report file information docx, 14. West virginias medicaid telehealth policy is based. In the months following this announcement, dhhrs bureau for medical services bms began to prepare for open enrollment beginning on october 1.
However, regulations and medicaid provider manuals do not reflect all of these. Providers can determine what has changed each month by following the release notes link on the texas medicaid provider procedures manual web page. Download adobe acrobat reader to open and read pdf documents from this site. The health plan will comply with ohio, west virginia, medicare and. Community plan care provider manuals for medicaid plans by. The complete updated medicaid national correct coding initiative ncci edit files are posted here at the beginning of each calendar quarter. The health plans provider manual contains comprehensive information related to best practices for the care of this population. Macpac report to congress on medicaid and chip march 2018. In calendar year 2014, wv medicaid reimbursed more than 6.
The west virginia medicaid pharmacy program is an optional feeforservice benefit offered to all eligible members, including those who are enrolled in medicaid managed care plans. Medicaid ncci change report files for edits effective january 1, 2020 medicaid ncci change report zip, 86. West virginia medicaid health homes provider manual. Model of care our model of care offers an integrated care management approach. The further consolidated appropriations act, 2020 pub. They also provide helpful tips on a variety of health and wellness topics, such as managing high blood pressure and cholesterol, when to see your doctor, and staying active.
Evs user manual, chapter 2 updated 0724 2017 pv 0729 2014 when a member is enrolled in an mco, emergency services are covered by the mco even if emergency services are provided outside of the mco provider network. West virginia medicare advantage compliance language. Aetna medicaid also provides medicaidrelated administrative services. Section 106 of this act mandates that, during the period beginning on january 1, 2020 and ending june 30, 2021, the adjustments to the medicare fee schedule amounts for certain durable medical equipment dme based on information from. West virginia state medicaid has no explicit policy regarding transgender health coverage and care see west virginia medicaid provider manual, ch 100 since at least 2005 wisconsin state medicaid policy explicitly covers transitionrelated health care explicitly excluded in 1996 see dhs 107. Medicaid provider reassignment regulation september, 2019. D24 7 the appellant went to doctors appointments at in west virginia on august 18, 2016 and october 17, 2016. Wv medicaid covid19 response for noninsured patients coronavirus testing. Policy manual west virginia department of health and. Providers must ensure services are delivered in accordance with the medicaid service provider manual and any other authorities in effect on the date of service. All opioid treatment program services provided under the october 2017 substance use. Prescribers not enrolled in the west virginia medicaid program may contact the wv medicaid enrollment department at 8884830793 for information on how to become an enrolled provider.
Aetna better health of west virginia 20162017 medical. It accompanies a survey issued to the health plans. Medicaid eligibility report fy2017 january 10, 2017. Check out our newsletters for the latest information on your benefits, services, and more. Please refer to the appropriate west virginia medicaid provider manual for coverage determination.
Effective july 1, 2014 pharmacy prior authorization insourcing provider update. Effective january 1, 2017, prior authorization from highmark is required for non. D2a screen print from wv bureau of medical services website publication section and copy of. Type name modified file size spring 2017 8152017 4. Aetna medicaid has more than 25 years experience in managing the care of the most medically vulnerable, using innovative approaches to achieve successful health care results. Due to the world health organization declaring coronavirus disease covid19 a pandemic, the west virginia bureau for medical services bms has expanded certain services and waived certain requirements that may be listed in the medicaid provider manual. Evs user manual, chapter 2 updated 07242017 pv 0729 2014 when a member is enrolled in an mco, emergency services are covered by the mco even if emergency services are provided outside of the mco provider network.
Find your local bureau on the provider opportunities by counties page. As of july 1, 2017, pharmacy services for wv medicaid managed care. This process will be conducted in a phasedin approach. Due to the world health organization declaring coronavirus disease covid19 a pandemic, the west virginia bureau for medical services bms is allowing all telehealth services listed in the bms policy manual, and the temporary telehealth services approved during the covid19. Chapter 506 durable medical equipment, prosthetics.
The unitedhealthcare community plan care provider administrative guide has been approved by the state of kansas. Hospital costtocharge ratio is used to reimburse a hospital for outpatient services on an interim basis. Notice 2014 7 provides guidance on the federal income tax treatment of certain payments to individual care. West virginia medicaid provider newsletter wv medicaid expansion update on may 2, 20, governor earl ray tomblin announced the expansion of the wv medicaid program.
Telehealth covid precautions message from cynthia beane, msw, lcsw, commissioner. The oig medicaid exclusion list must be checked for every agency employee who provides medicaid services prior to employment and monthly thereafter. You need to check with your county dhhr office to determine if you meet the income guidelines. Should your particular issue or concern not be addressed in the provider manual, please call provider services at 3128648200 8554441661 711 ttdtty. Molina healthcare updates and publishes the provider manual once a year. Wv medicaid and chip joint provider enrollment application. In addition to the items above, the following information is available. Provider manuals provider manuals these manuals are official publications of the virginia department of medical assistance services dmas and their contents are to the extent appropriate incorporated by reference into participation agreements signed by providers enrolled in the virginia medicaid program. May 5, 2014, that the practice of providers giving a preservice denial notice to members in. This manual details our referral process, quality standards, credentialing and reimbursement process. Aetna medicaid also provides medicaidrelated administrative services to new hampshires medicaid program.
1232 392 1193 518 85 751 1000 556 1152 1200 572 890 149 844 280 72 1102 289 21 1432 1356 638 89 304 1480 51 19 1070 762 1578 1576 799 725 18 1338 1413 1007 166 960 1204