Value-based care is transforming the healthcare industry. State and Federal requirements. Behavioral Health - Unicare Community Health Center! If you think you could possibly have unclaimed funds in the State of West Virginia, you might want to check this website: https://wv.findyourunclaimedproperty.com/app/claim-search, You can also callthe State Treasurer's office at1-800-642-8687. Or choose Go on to move forward to Aetna.com. Member Materials | UniCare - Anthem Shop and compare competitively priced health, dental, vision, Medicaid and employer plans today! The West Virginia Childrens Health Insurance Program (WVCHIP) joinedthe West Virginia Mountain Health Trust (MHT) managed care program effective January 1, 2021. Claims may be mailed or submitted throught the provider portal. We offer EPHC providers population health reports that can help support healthier patients. There is also aMedicaid work incentivefor those between the ages of 16 and 65 who are disabled and are working. Contact WVU's Rational Drug Therapy Program at Individuals & Families Customer Service For membership inquiries please contact us by email at: Individual.Membership@Unicare.com. You must also update your address with the DHHR Customer Service Center. Chapter 530 focuses on speech and audiology services; while Chapter Last Updated 07/21/2023 The dates below are used for Medicare compliance and do not apply to provider data updates. Click here to view WVCHIP's maintain current, accurate, legible and complete documentation to justify Providers | UniCare State Indemnity Plan Stay Informed About the COVID-19 Virus Your health is our priority. For more information about Enhanced Personal Health Care or to learn how to begin your care transformation, please e-mail us atUniCareProviderRelations@anthem.com. Take your Health Risk Screener (HRS). Co-payments for drugs on the new PDL will remain the same. There are two types of WV Health Homes: Behavioral and Diabetes. Welcome. PDF WEST VIRGINIA PROVIDER MANUAL - UniCare , Ambulance Fee ScheduleAmbulatory Surgery Center RatesDental Fee ScheduleDRG Weights UpdatesDrug-Free Mom and Baby (DFMB) Fee ScheduleEmergency Department Fee ScheduleHospice County RatesHospital OP Surgery Max UnitsLicensed Behavioral Health Center Fee ScheduleArchive Fee Schedules, Aged andDisabled Waiver (ADW) RatesChildren with Serious Emotional Disorder Waiver (CSEDW)Intellectual/Developmental Disabilities Waiver (IDDW)Traumatic Brain Injury Waiver (TBIW), 350 Capitol Street | Room 251 | Charleston, WV 25301 | Phone: (304) 558-1700 |, Drug-Free Mom and Baby (DFMB) Fee Schedule, Licensed Behavioral Health Center Fee Schedule, Children with Serious Emotional Disorder Waiver (CSEDW), Intellectual/Developmental Disabilities Waiver (IDDW). Free translation services. This page provides links to information Medicaid Providers may need in order to better serve their patients and/or to better understand the Medicaid Program. Providers may bill WVCHIP electronically through Gainwell Technologies with an active provider enrollment and Trading Partner Agreement (TPA). Your dashboard may experience future loading problems if not resolved. In addition to the items above, the following information is available: . Let's find a plan to fit you, in a few short steps. For adults Adults (ages 21+ for Medicaid and ages 20+ for CHIP) can get covered services, including: Check-ups (twice a year) Cleaning (every six months) X-rays (once a year) Dental restorative services (fillings, implants and crowns), with a $1,000 annual limit (Medicaid members) For children Requests for prior authorization should be submitted to the contracted utilization management organization, as early as possible in advance of the service/item. I also agree that by submitting this Contact Request form, I am bound by Medicare Health Benefits, LLC Privacy Policy and Terms of Use. All practitioners must This is called the spend down program and is especially common for people who are aged, blind, and/or disabled. Need help sorting through your options? OurEpisode-Based Payment(EBP) program is a bundled payment program for specialty physician groups and facilities that targets a range of treatment courses (or "episodes"). Providers Medicaid Medicare Contact Us 2023 UniCare UniCare is a PDP plan with a Medicare contract. Learn More UniCare Providers We're here to work with you to improve the health care of UniCare GIC members. I also agree that I am not required to submit this form or agree to these terms as a condition to receive any property, goods, or services that may be offered, and that I may revoke my consent at any time using reasonable means, including by calling 855-781-8801or emailing revokeconsent@medicarehealthbenefits.com. Yes, some plan members have copayments for certain medical and prescription services. The WV Medicaid program provides healthcare to well over 500,000 low-income or disabled people each year. This payment model is part of our work to move to a healthcare system where payment is based on value rather than volume. Even if you do not qualify according to the figures below, you may be eligible if you spend enough money on your healthcare services to find yourself at the numbers below. recommends, or approves medical care does not in itself make the care medically Enhanced Personal Health Care (EPHC) is UniCares patient-centered, value-based care program. WV Medicaid Physician's Fee Schedules Within your MCO, youll need to choose your PCP, or Primary Care Physician. Pregnant women, kids under 21, and Native Americans are exempt from co-payments. 10/3/2022 1:49 PM. Call UniCare Customer Service at 800-442-9300. Your PCP can refer you to other doctors and specialists. The child's doctor must call RDTP. For list of Inpatient, Outpatient and Specialized Services see Jun 17, 2020 WHEELING The Health Plan is one of three health insurance providers awarded a statewide Medicaid contract for the next three years through the Mountain Health Trust managed. Nashville, TN 37209, MULTIPLAN_MEDICAREPLANFINDER1_2023 (PENDING). WVCHIP will cover, and your pharmacist can dispense, up to a five-day supply of a medication requiring prior authorization for the applicable copayment. Or choose Go on to move forward to the provider website. Please see the following information regarding the ongoing transition to align WVCHIP benefits to WV Medicaid, due to the West Virginia Legislature's, House Bill 4649. These people can receive Medicaid even without meeting the income requirements if they pay a $50 enrollment fee and a monthly premium. If you dont want to leave our site, choose the X in the upper right corner to close this message. Mountain Health Trust provides managed care services to approximately 87% of the state's Medicaid membership. 1-855-230-7778. Medical Policies, Clinical UM Guidelines, & Clinical Criteria. Any information we provide is limited to those plans we do offer in your area. Mountain Health Trust and the West Virginia Health Bridge Alternative Benefit Plan are the managed care organizations (MCOs) for the West Virginia Medicaid program. ContactGainwell Technologiesat . Cost savings and positive outcomes continue to improve through a consistent patient-provider relationship; the longer a patient stays with an EPHC provider, the more the benefits compound. Renew It may be time to renew yourhealth benefits. WEST VIRGINIA PROVIDER MANUAL WVUNI-CD-PM-019362-23 West Virginia Mountain Health Trust https://provider.unicare.com UniCare Health Plan of West Virginia, Inc. WVUNI-CD-PM-019362-23 April 2023 This page is left intentionally blank. Executive Director, WVCHIP 350 Capitol Street Room 251 Charleston, WV 25301 Fax: Practices with smaller populations. WVCHIP Preferred Drug List. Welcome to Health PAS-OnLine, West Virginia Medicaid and CHIP's web portal for Members and Providers. All specialty medications require prior authorization. Provider Enrollment All providers who would like to offer services to Medicaid members are federally required to enroll and revalidate with West Virginia Medicaid through Molina Medicaid Solutions West Virginia Medicaid covers family planning and counseling, pregnancy tests, STI tests, sterilization, and gynecologist services such as pap smears, birth control visits, and lab tests. Click here for the The first WV Health Home started in July of 2014 in southern West Virginia. Mountain Health Trust and the West Virginia Health Bridge Alternative Plan, Dual Eligible Medicare and Medicaid Plans in West Virginia, Medicare Part A: Coverage and Costs for 2020, Understanding Medicare Part B: Coverage and Costs for 2020, Physical and occupational therapy (20 visits per year), Home health (60 visits per year, more with authorization), Early periodic screening, diagnosis, and treatment, Tier 1: Up to 50% of the FPL Max $8 out-of-pocket, Tier 2: 50-100% of the FPL Max $71 out-of-pocket, Tier 3: At or above 100% of the FPL Max $143 out-of-pocket. Medicare Plan Finder is a nationally licensed insurance agency based in Nashville, TN & Tucson, AZ. Those who were already established on these medications prior toAugust 1, 2009, may continue to receive these medications, however, prior authorization must be renewed annually. I acknowledge and understand that by submitting my phone number and information and clicking Next, such action constitutes a signed written agreement that I may be contacted by Medicare Health Benefits, LLC, Continental Health Alliance, LLC, Medicareplanfinder.com, and their affiliates (listed here as Advocates), via e-mails, SMS, phone calls and prerecorded messages at any phone number(s) that I provide, even if the number is a wireless number or on any federal or state do-not-call list, and I represent and warrant that I am the primary user and subscriber to any phone number I submit. Medicaid is for low-income and working individuals or families, their children, pregnant women, and those in foster care or adoption assistance. services such as evaluation and management, preventive, emergency department, If you are eligible for West Virginia Medicaid and are also over the age of 65, diagnosed with ALS or ESRD, or have been receiving SSDI (Social Security Disability Income) for at least 25 months, you may be dual eligible. Dual eligibility means that you can obtain coverage from both Medicaid andWest Virginia Medicare. Receiving calls and/or text messages from Aetna Better Health ofWest Virginiathat are informational and relate to my health and benefits. For claim appeals, out-of-state,claims management,incorrect payment, timely filing and dental claims, appeal in writing to Gainwell Technologies. visit their website. for Medicaid benefits. , The Centers for Medicare & Medicaid Services (CMS) Payment Error Rate Measurement (PERM) Program for Reporting Year (RY) 2023 is currently reviewing the WV Medicaid and WV Children's Health Insurance program (WVCHIP) to measure imporoper payments in order to maintain the integrity of the Medicaid program. Aetna Better Health of West Virginia When you choose us as your Medicaid or CHIP plan, you make the choice for better health. Medicaid eligible individuals can be billed by the provider for services West Virginia Medicaid denies under the following circumstances: 1) client was not Medicaid eligible at the time of services, 2) service rendered to the client is not a Medicaid covered service, 3) service rendered to the client exceeds Medicaid Program coverage or service . eligibility and obtain appropriate authorizations before services are If you dont want to leave the member site, choose the X in the upper right corner to close this message. Providers must use the standard CMS (Formerly HCFA) 1500 Claim Form to request reimbursement for services. Street Address: City: State: Zip: West Virginia Line of Business Select Line of Business WV Medicaid WV Chip Drug name, CPT/HCPCS Code or Code Description To determine coverage of a particular service or procedure for a specific member: Access eligibility and benefits information on the Availity Essentials . PDF Provider Appeal Request Form - UniCare KEPROprovides medical case managment services to WVCHIP members experiencing a serious or long-term illness or injury. Do WVCHIP members have copayments for medical services? The main differences between the two programs are a few coverage limits. UniCare offers various programs to support organizations through this change and provide the tools they need to deliver higher quality patient care and lower costs. Enhanced Personal Health Care enables providers to deliver better outcomes, improved care quality, and significant cost savings. See our Explore Our Plans page for links to detailed benefits information for UniCare members. A. Prescription drug benefits are administered by Express Scripts, Inc. (ESI). Eligibility depends on your household income and the number of people in your household. copayment information. 3/30/2022 2:58 PM. https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html, https://www.hhs.gov/sites/default/files/provider-relief-fund-medicaid-chip-factsheet.pdf, Delivery of Clinical Preventive Services Combined.pdf, WVCHIP Provisional ProviderEnrollment Letter, Critical Care Access Hospitals Fee Schedule (4-12-21), Drugs and Biologicals Fee Schedule (2021), Durable Medical Equipment Fee Schedule (2021), Home Infusion Therapy Fee Schedule (1-1-06), Reimbursement for Developmental Screenings in Pre-School Children, Cause more severe side effects than traditional drugs, Need special storage, handling and/or administration, Require periodic laboratory or diagnostic testing. A. Attention Adult Dental Program Providers! - West Virginia Department of West Virginia Medicaid offers a comprehensive scope of medically necessary This page provides links to information Medicaid Providers may need in order to better serve their patients and/or to better understand the Medicaid Program. Click here for the Physicians and other health care professionals are paid accordingly to a Resource Based Relative Value Scale (RBRVS) fee schedule. Once accepted into the program, you will receive a packet in the mail which will tell you which MCO program you are in. Were here for you 24 hours a day, 7 days a week. Powered by Medicare Health Benefits. necessary or a covered service; nor does it mean that the patient is eligible For example, the Health Bridge program does not include nursing home coverage and has a limit of 24 chiropractic treatments per year. If you dont want to leave our site, choose the X in the upper right corner to close this message. The expansion allowed people living at up to 138% of theFederal Poverty Levelto have access to Medicaid (158% for pregnant women and 300% for kids). provided in the appropriate settings. You dont need a referral or approval for emergencies. Any covered and authorized service must be West Virginia Medicaid offers a comprehensive scope of medically necessary medical and dental health services. Your location must be a medically necessary appointment that is covered by Medicaid. You'll have access to: Get detailed eligibility and benefits information Submit medical claims online Monitor the status of claims submissions Don't have an account? Just be sure to show your member ID card at every visit. Search your medical plan without logging in. We do not offer every plan available in your area. Clinicians must maintain access to clinical services in environments that are safe for all. Call our team today and get your questions answered with. Click here for more Information . Ground Ambulance Fee Schedule (2-19-14) Read letter to providers for more information. Medicare Plan Finder is a non-government entity powered by Medicare Health Benefits, a health insurance agency. We're here for members statewide. Note:Prior Authorization Unicare provides behavioral health and access to social services, because this can play an important role in one's overall health. For additional information, please call the provider support line at Through a West Virginia DSNP plan, you can have all of the major benefits you need at little or no cost. or by calling the Gainwell Technologies Provider Relations department at (888)483-0793. EPHC for patient-centered primary care, EPHC Essentials (and Discover the Best Rates, for FREE). Our licensed agents are readily available. UNICARE - Your Provider Locator - EyeMed Vision Benefits How to Schedule an Appointment 15 . We work with SKYGEN to provide adults and children with dental and oral health care. When services require prior authorizations, a request with Your Health Home can work with the doctors who treat you now, so taking advantage of the Health Home benefit does not mean that you have to switch doctors! Better healthcare equals greater earnings. Go to the emergency room for medical emergencies when your life is in danger. Include your name, e-mail, practice name, tax ID, and phone number with area code. Notice of Privacy Practices. Reporting includes alerts for patients who are due for critical screening or who may be at a higher risk for chronic conditions. . Q. Providers - West Virginia Department of Health and Human Resources New to UniCare? HHS (US Health & Human Services) expects to distribute $15 billion to eligible providers that participate in state Medicaid/CHIP programs or Medicaid managed care plans and have not yet received a payment from the Provider Relief Fund General Distribution allocation. Please visit hhs.gov/providerrelief for eligibility requrements, Terms and Conditions, Frequently Asked Questions (FAQs) and a recording of past webinars on the application process. Does my office have to precertify any medical services for a WVCHIP patient?, A. You canapplythrough the healthcare marketplace online or through WV inroads, the West Virginia Department of Health and Human Services (DHHS) website for all state benefits. The drugs on thepreferred drug listwill act as your formulary. Youll also find information about prior authorization, meaning that there are certain drugs that you will need to have Medicaid approve before you retrieve your prescription at the Medicaid rate. To contact KEPRO, call services. MHP serves children and youth who are in foster care, kinship care, or adoptive care, those eligible for theCSEDW(Children with Serious Emotional Disorder Waiver)and youth formerly in foster care up to age twenty-six (26) who aged out of foster care while enrolled in Medicaid in the state of West Virginia. Any provider still wishing to dispute the amount or denial of reimbursement may file an appeal in writing to: Aetna provides the info on the next page. The following fee schedules will now be effective April 1st throughMarch 31st starting in calendar year(CY) 2019: Disclaimer: Notethat 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. Clinical Lab Fee Schedule (2021) current Another group or vendor provides the info on the next page. Vision coverage follows similar regulations. Summary Plan Description. West Virginia Medicaid | UniCare Medicaid and WVCHIP insurance in West Virginia Ready. Log in to Availity Need an account? Mental health patients with Medicaid have access to psychiatric hospitals and treatment facilities, psychologists, behavioral health centers, and clinical social workers as well as mental health-related prescription drugs. 173 KB. Or maybe you dont have a dentist? Copyright 2016-2023 MedicarePlanFinder.com. Prior Approval Form for Out of State / Out of Network Services If you want to stay on our site, choose the X in the upper right corner to close this message.
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