To navigate through the ribbon, use standard browser navigation keys. Policy and procedures manual october 2017 empowering families for healthy beginnings mission statement. Until 2014, the free care policy, sometimes referred to as the free care rule, precluded medicaid from paying for the costs of medicaidcoverable. Authorized under title xix of the social security act, medicaid is an entitlement program financed by the state and. The complete updated medicaid national correct coding initiative ncci edit files are posted here at the beginning of each calendar quarter. 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. Our service areas include all cities and counties in west virginia. 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. Until 2014, the free care policy, sometimes referred to as the free care rule, precluded medi caid from. Providers must ensure services are delivered in accordance with the medicaid service provider manual and any other authorities in. If you need an older version of an administrative guide or care provider manual, please contact your provider advocate.
Free standing or hospital based ordered ambulatory manual billing guidelines pdf, 462. Aetna medicaid also provides medicaid related administrative services to new hampshires medicaid program. Behavioral health medical directors make all final coverage denial determinations involving clinical issues. The louisiana medicaid dme program covers the least costly alternative based on the. State telehealth laws and reimbursement policies report. Please refer to the covid19 alerts and updates page for specific changes and updates. Medicaid rehabilitation option services overview medicaid rehabilitation option mro services are designed to assist in the rehabilitation of the. Bms has a joint goal with medicaid enrolled providers to ensure effective services are provided to medicaid members. Free standing or hospital based ordered ambulatory manual policy guidelines pdf, 11. Type name modified file size wv medicaid newsletters 2020 352020 4. Medical policies and clinical utilization management guidelines update. Medicaid is required to exempt these drug claims from drug rebate invoicing. Select a link to download the appropriate document.
Questions regarding medicaid eligibility, provider enrollment, status of claims or other billing. Call aetna better healths fraud, waste and abuse tollfree number at. Authorized under title xix of the social security act, medicaid is an entitlement program financed by the state and federal governments and administered by the state. Were committed to giving you the tools, education and resources needed to easily work with us. There is a document available at the bottom of this page, the hcris faq, which answers some questions about hcris, the data files, and the cost reporting process. To ensure all transition navigator providers for the wv medicaids money. Please see the appendices for details regarding the beacon services associated with your contracted plan. About this manual this manual serves as a resource to practitioners providers and outlines operations for aetna better health of west virginia. This booklet provides you with a brief overview of the west virginia medicaid program and the services available to you. Links to various nonaetna sites are provided for your convenience only. Identifying, notifying and reducing the number of consumers enrolled in marketplace coverage with aptc or csrs and medicaid or chip march 17, 2017 slides spring 2017 medicaidchip periodic data matching faq posted april 2017. Medicaid eligibility is determined based on income and other factors, depending on your eligibility category. Division of medicaid and health financing for epsdt eligible individuals. The program policy was established in wv medicaid chapter 535 and utilized to establish kepros utilization guidelines.
Please make a selection for the linkdocumentation desired. Other bms provider requirements as a medicaid provider, leas are not only responsible for compliance with the sbhs policy manual chapter 538, but they must be in compliance with chapt ers 100, 200, 300, 400, 800a and 800b of the west virginia medicaid policies. Medicaid eligibility in west virginia medicare pdf list. Please refer to the appropriate west virginia medicaid provider manual for coverage determination. Chapter 5 intellectual and developmental disabilities waiver iddw bms provider manual page 1 chapter 5 intellectual and developmental disabilities waiver iddw effective 02012018. Submitted ffy 2017 health homes quality measures for the first. Hcbstbi waiver services manual billing guidelines pdf, 168.
If it is not installed on your computer, you can download it for free from adobe. Updates are generally available the month following the effective date of the change. However, if a provider chooses to participate, heshe must accept the medicaid payment as payment in full for medicaid covered services. If a treating provider doesnt agree with a decision about.
If medicaid has already paid for your care, a refund must be made to. Apr 17, 2014 the virginia medicaid web portal can be accessed through the following link. At lower income levels, families may be eligible for wv medicaid. Health care providers, who, under the state plan andor state statute are required to be licensed in west virginia wv or the state in which they practice, must maintain and ensure that a current license is on file at all times with west virginia bureau for medical services bms provider enrollment unit, molina. In addition to the items above, the following information is available. To view pdf files, you will need the adobe acrobat reader, which is free, and can be accessed from the adobe link at the top of this page. Provider manuals for fy 2020 fy 2020 provider manual for community behavioral. Wv medicaid will not override the denial at the pharmacy, and no exceptions will be made. Medicaid enrolled providers should give priority to children that have been identified as being in the foster care system.
Beginning january 1, 2014, wv medicaid copayment amounts for eligible. Provide professional, individualized and comprehensive care. August 3, 2015 special education director webinar powerpoint. Medicaid billing changes west virginia department of. Please refer to the dmas provider memo, dated 66 2017, launch of commonwealth coordinated care ccc plus waiver effective july 1. Npi is a 10digit, intelligencefree numeric identifier.
The following is the list of available options within this category. Download adobe acrobat reader to open and read pdf documents from this site. Wv medicaid encourages providers to render services via telehealth in the behavioral health clinic services program. Medicaid coverage of dental benefits for adults macpac. Medicaidchip periodic data matching medicaidchip pdm. Your 2017 guide to medicaid a program administered by the west virginia department of health and human resources.
This page provides links to information medicaid providers may need in order to better serve their patients andor to better understand the medicaid program. Applehealth 2014, wellcare 2014, west virginia bms 2015, west. As of january 1, 2014, some individuals who receive. Note that links within the manual have been activated in this revised version. Dental health is an important part of peoples overall health. The west virginia medicaid program is administered pursuant to title xix of the social security act and. 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. These terms are intended to supplement the medicare advantage and medicaid requirements found in the provider services agreements psas of providers participating in the medicare advantage and. Table of contents west virginia department of health and. Medicaid rehabilitation option mro provider manual library reference number. Policy and procedures manual west virginia department of. Indication or presence of fee in the table below does not guarantee coverage.
Cchp examined state law, state administrative codes, and medicaid provider manuals as the reports primary resources. If you have any other questions, please feel free to call us at 1800medicare. Your 2017 guide to medicaid west virginia department of health. Hcbstbi waiver services manual policy guidelines pdf, 47. West virginia state telehealth laws and reimbursement policies. Medicaid updates august 2015 recording from august 3, 2015. Kidstrong conference school nursing medicaid presentation june 22, 2016 pdf. Note that the absence or presence of a reimbursement code and its associated allowance on these pages does not guarantee medicaid coverage of the item or procedure. Jan 16, 2018 medicaid eligibility in west virginia.
Wv medicaid physicians rbrvs fee schedules page content disclaimer. Behavioral health policy and procedure manual for providers. Your 2017 guide to medicaid a program administered by the west virginia. Individual cost reports may be requested from the medicare administrative contractors via the freedom of information act foia.
The effective date of the ccc plus waiver is july 1, 2017 and should not be confused with the implementation of the commonwealth coordinated care plus ccc plus managed care program effective august 1, 2017. Kidstrong conference school nursing medicaid presentation june 22, 2016. State of west virginia department of health andhuman. Wvchip was created to help working families who do not have health insurance for their children. Behavioral health provider manual pdf scion dental provider manual pdf. Effective july 1, 2014 pharmacy prior authorization insourcing provider update. 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. Mountain health trust mht, west virginias medicaid managed care. The mission of the west virginia office of epidemiology and prevention services is to improve the health, wellbeing and quality of life for all west virginians through disease surveillance, investigation, analysis, education and prevention services. 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. Florida workers compensation health care provider reimbursement manual 2016 edition page 10 effective date. Aetna medicaid also provides medicaid related administrative services to new. Map has tracked state medicaid policies since at least 2017.
West virginia family health wvfh provider manual pdf west virginia family. Find answers to frequently asked questions about national correct coding initiative ncci methodologies in the faq library. The purpose is to provide appropriate medical programs and quality of health care services to all west virginians. It contains information about texas medicaid feeforservice benefits, policies, and procedures including medical, dental, and childrens services benefits. Providers of dme must be enrolled in order to participate in this program. Dbhdd publishes its expectations, requirements, and standards for community providers via policies and the respective behavioral health or developmental disabilities provider manuals. These chapters are applicable to all medicaid providers and cover topics such. This booklet provides you with a brief overview of the west virginia medicaid program and the services. West virginia medicaid health homes provider manual version 1. Quarterly pharmacy formulary change notice effective february 1, 2017. West virginia medicaid application information dhhr is dedicated to providing the medicaid programs while keeping a good balance between the resources and number of applicants. Aetna better health of west virginia 20162017 medical.
If youre a provider of unicare health plan of west virginia, inc. As a provider that has the dhhr employee newsletter west virginia department of jan 19, 2016 west virginia medicaid provider. Medicaid programs must follow the competitive bidding fee schedules for durable medical equipment dme published by medicare. Wv state plan amendment 1125 2014 state plan amendment effective 71 2014. You may like commonwealth virginia medicare part b 2020 west virginia medicaid regulations 2019 west virginia medicaid provider application 2019 west virginia medicaid.
Follows the person mfp program, called take me home george galleta information. 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. This is a federal rule and the medicaid pharmacy program must follow it. West virginia medicaid billing instructions are posted below. These data replace the medicaid ncci edit files from previous calendar quarters. To find the contact information for your provider advocate, go to find a network contact, and then select your state. 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. See west virginia medicaid provider manual, ch 100 since at least 2005 wisconsin. 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. Through the manual, practitioners and providers should be able to identify information on the majority of. 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. November, 2014 policies and procedures as of june 1, 2014 version. Reform provider payments ohio health transformation jan 30, 2017 adopts a single preferred drug list for the medicaid pharmacy benefit track to be turned on in july 2017, along with an aprdrg pricing update.
Aug 01, 2015 medicaid eligibility report fy2017 january 10, 2017. Aetna medicaid has more than 25 years experience in managing the care of the most medically vulnerable, using. The manuals are updated quarterly throughout each fiscal year july june, and are posted one month prior to the effective date. The following chapters of the bms provider manual will be updated on an ongoing basis to. Wv medicaid durable medical equipment cy 2017 fee schedule disclaimer. Medicaid billing changes west virginia department of education. Medicaid coverage for transitionrelated care no updates required since november 21, 2019. States are required to provide dental benefits to children covered by medicaid and the childrens health insurance program chip, but states choose whether to provide dental benefits for adults. Please be advised that the west virginia medicaid provider manual does not address all the.
West virginia medicaid population for the west virginia family health plan, inc. 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. The manual is regularly updated to reflect the most recent policy and procedure changes. This hearing was held in accordance with the provisions found in chapter 700 of the west virginia department of health and human resources common chapters manual. Behavioral health policy and procedure manual for providers mvp health care this document contains chapters 18 of beacons behavioral health policy and procedure manual for providers. You also can call our community resource center toll free at 18886119958 and speak with our staff dedicated to serving our providers. July 1, 2017 chapter 1 introduction and overview, continued administrative purpose of the manual the administrative purpose of the florida workers compensation. This document contains chapters 18 of beacons behavioral health policy and procedure manual for providers serving partnership healthplan of california insurance members. One good way to keep them healthy is making sure they get medical care.
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. To ensure all transition navigator providers for the wv medicaid s money. Aetna medicaid also provides medicaid related administrative services. Texas medicaid provider procedures manual this manual is a comprehensive guide for texas medicaid providers. However, medicaid is not a guaranteed source of funds for schoolbased services for children.
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