Jul 01, 2019 only a limited number of procedures not available from any west virginia provider are permitted from outofstate providers for plan d members and require prior authorization from umr. Dme supplies required to be billed through the pharmacy system. Please be advised that the west virginia medicaid provider manual does not address all. Durable medicaid equipment, prosthetics, orthotics, and supplies. General information as well as other sections and attachments. The alabama medicaid provider billing manual is a practical guide to assist medicaid enrolled providers in receiving reimbursement. Dual eligible special needs plan dsnp medical management. Referring choose if requestor will not be billing wv medicaid for requested. Chapter 506 durable medical equipment, prosthetics, orthotics and. Provider manual aetna better health of west virginia. At aetna better health of west virginia, we believe in improving every life we touch as good stewards to those we serve.
The health plan medicare advantage members including securecare hmo, securechoice ppo and dualeligible special needs plan will utilize superior vision for routine eye care beginning january 1, 2020. As of july 1, 2017, pharmacy services for wv medicaid managed care organization mco members will be administered by the traditional feeforservice pharmacy program. Per the centers for medicare and medicaid services cms, medicaid programs must follow the competitive bidding fee schedules for durable medical equipment dme published by medicare. Dmas will not provide rental reimbursement for days on which the recipient did not use the item. This page provides links to information medicaid providers may need in order to better serve their patients andor to better understand the medicaid program. This is a federal rule and the medicaid pharmacy program must follow it.
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. For more information about the durable medical equipment program, please visit our fiscal agents web portal. Network practitionersproviders training materials and the provider manual include west virginia medicaid covered services information. Download adobe acrobat reader to open and read pdf documents from this site. Checklist for durable medical equipment information on denials, reasons for recoupments, where to find information in the medicaid provider billing manual, free tools and contacts for providers to use in preventing fraud and abuse 10116. 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. 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. Introduction to the network management and operations department. The cms program components, providers, contractors, medicare advantage organizations and state survey agencies use the ioms to administer. Chip providers provisional provider enrollment since june 30, 2016, all providers must be fully enrolled with chip to have your claims processed and paid. 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 competitive bidding programs not be applied to wheelchair accessories including seating systems and seat and. Aetna better health of west virginia home aetna medicaid.
Chapter 506 durable medical equipment, prosthetics, orthotics, and supplies dmepos bms provider manual page 1 chapter 506 durable medical equipment, prosthetics, orthotics, and supplies dmepos revised 1012015. Durable medical equipment dme fee schedule west virginia. Prior to discussing medicaids role in paying for durable medical equipment dme, it is helpful to briefly explain how medicaid works. For additional information about home health supplies, please contact the home health policy manager.
We partner with providers who deliver quality and effective care to. To access a provider enrollment application, providers must be a registered trading partner on the health pasonline web portal. Jul 01, 2019 nd medicaid dme purchase fee schedule posted as of 102007 effective 7107. This manual will provide you with information about molina and will describe how we will work together as you care for your patients health care needs. They are cms program issuances, daytoday operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. Provider manual with billing instructions for hha, acc and erc providers.
Department policy material is updated periodically and it is the responsibility of the users to check and make sure that the policy they are researching or applying has the correct effective date for their circumstances. Do you have durable medical equipment dme coverage. Medical supplies and durable medical equipment utah medicaid. As such, current wvfh members will be transitioned to another managed care organization between may 1 and july 1. Attachment iii wv medicaid dme medical supplies authorization request form 010106 031506. West virginia medicaid reimburses covered services to enrolled providers for durable medical equipment. You may like commonwealth virginia medicare part b 2020 west virginia medicaid regulations 2019 west virginia medicaid provider application 2019 west virginia medicaid. Division of medicaid and health financing for epsdt eligible individuals. Beginning january 1, 2014, wv medicaid co payment amounts for eligible members are based on the following. Call dxc technology at 18884830793 with questions or to confirm you are fully enrolled, or to find out about enrolling. To navigate through the ribbon, use standard browser navigation keys. Scdhhs policy below describes dme covered supplies and equipment.
In west virginia, the office of health facility licensure and certification ohflac is the certifying agency. Must provide a copy of medicare certification along with the rate of reimbursement set by medicare. The health plans provider manual contains comprehensive information related to best practices for the care of this population. Durable medical equipment provider manual chapter eighteen of the medicaid services manual issued september 1, 2010 state of louisiana bureau of health services financing claimsauthorizations for dates of service on or after october 1, 2015. As an aetna better health of west virginia provider, there are certain procedures and protocols you need to know. Durable medical equipment, prosthetics, orthotics, and medical supplies dmepos this manual has information specific to your provider type. Policy manual west virginia department of health and human. This page contain links to the ms department of medicaid s policy manual. 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.
This chapter does not address all the complexities of medicaid policies and procedures, and must be. Doh medicaid update website provides uptodate changes that may affect your participation in the medicaid program mevs and supplemental documentation this information is not part of your provider manual, however, it may be useful information and is placed here for your convenience. Medicaid billing changes west virginia department of. Click on provider services and then under provider support, you may choose from a variety of options that include provider handbooks and provider fee schedules. Wv medicaid prior authorization forms all documents. Physical therapy, occupational therapy and speech language therapy. Abhwv bh provider manual 20182019 aetna better health.
The caresource provider manual is intended as a resource for working with our plan. Medicaid manual with general information for all provider types. Link to list of updates and revisions to provider manuals. Provider manual with billing instructions related to pharmacy claims. Virginia department of medical assistance services dme and. Printing the manual material found at this website for longterm use is not advisable.
This provider manual is designed for physicians, hospitals and ancillary providers. Effective october 1, 2010, states were required by the centers for medicare and medicaid services cms to incorporate all national correct coding initiative ncci methodologies into their systems for processing medicaid claims. No provider shall have a claim of ownership on dme reimbursed by virginia medicaid once it has been delivered to the medicaid individual. 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. For additional information about durable medical equipment, please contact the dme policy manager. Wv medicaid will not override the denial at the pharmacy, and no exceptions will be made.
Table of contents west virginia department of health and. See list of medical items medicare pays costs for, like beds, oxygen, pumps, canes, more. Provider paymentreimbursement information health care providers are reimbursed according to the maximum schedule and rates established by wvchip. Telemedicine is viewed as a costeffective alternative to the more traditional facetoface way of providing medical care e. We believe in delivering care through a collaborative approach. Beginning january 1, 2014, wv medicaid copayment amounts for eligible members are based on the following. Kepro provider operations manual r wv medicaid behavioral health services. The following chapters of the bms provider manual will be updated on an ongoing basis to reflect. Wv medicaid prior authorization form todays date fax 1844.
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. Medicaid reimbursement for rental items is a daily rate. The combination of kepro and aps healthcare in 2015 created an organization. Doh medicaid update website provides uptodate changes that may affect your participation in the medicaid program mevs and supplemental documentation this information is not part of your provider manual, however, it may be useful information and is placed here for your convenience ordering information contact information you can use to order hard paperbased copies of emedny manuals. These chapters are applicable to all medicaid providers and cover topics such. Unicare health care professionals do what they do best care for our members. Home health care and durable medical equipment dme. Until all chapters are updated, this notice serves to inform providers that the required ncci methodologies supersede any language in the bms provider manual chapters as it relates to coding andor the processing of claims submitted for services provided to wv medicaid members. Care provider manual florida statewide medicaid managed care. Chapter rural health clinic rhc and federally qualified health center fqhc services pdf see mm11019 pdf fqhc preventive services pdf information on preventive services in fqhcs including hcpcs coding, same day billing, and waivers of.
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. 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. Welcome to health pasonline, west virginia medicaid and chips web portal for members and providers. To help alleviate this problem, molina would like to offer the option to enroll with wv medicaid for medicare crossover purposes only. You will find frequently used forms both online and pdf, provider manuals and directories, precertification information, policies, benefit matrices. Must provide a copy of medicare certification along with the rate of reimbursement set by medicare for each service. All contracted practitioners providers collectively referred to going forward in this manual as provider or providers will be notified of any additional updates or changes that occur either via the provider newsletter or by letter. Wvchip was created to help working families who do not have health insurance for their children. Ndbn medicaid tracking chart national diaper bank network.
Early and periodic screening, diagnosis, and treatment epsdt early and periodic screening, diagnosis, and treatment epsdt is a federally mandated comprehensive child health program for medicaid members. Updates and changes to this manual will be forwarded to your office as they become available. Sponsored plan providers west virginia medicaid managed care. Dental health is an important part of peoples overall health.
Providers must be contracted with superior vision in order to treat medicare. Credentialing accreditation for dme, orthotics, and prosthetic providers 27. If labor and parts charges are not separately itemized on the invoice as required by 18nycrr 505. 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. Medicaid will pay for a service or item when the service or item is covered under the south carolina. If you wish to enroll for medicare crossover purposes only, you will need to complete a west virginia medicaid enrollment application. Table of contents west virginia department of health. Durable medical equipment dme fee schedule wv dhhr. Kepro is a qiolike entity designated by the centers for medicare and medicaid services. The unitedhealthcare community plan of florida physician, health care professional, facility and ancillary care provider manual applies to the following plans.
Provider resources on this site, you will find resources that help unicare health plan of west virginia, inc. Internetonly manuals ioms cms centers for medicare. Select the appropriate durable medical equipment document. Provider administrative and billing manual forms section 4 procedure codes. The texas medicaid provider procedures manual is the providers principal source of information about texas medicaid. Durable medical equipment, medical supplies, and nutritional products handbook. 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. The following is the list of available options within this category. The provider should always rely on its own counsel to ensure compliance with the medicaid laws. If a providers charge is higher than the wvchip maximum fee for a particular service, the plan will only allow the maximum fee. Check out our newsletters for the latest information on your benefits, services, and more. The following communications for west virginia medicaid managed care are available to our providers. 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.
One good way to keep them healthy is making sure they get medical care. To request a durable medical equipment authorization, providers will submit via. This website provides information to west virginia medicaid members, providers, trading partners and the public. Federally qualified health centers fqhc center cms. The internetonly manuals ioms are a replica of the agencys official record copy. Please refer to the appropriate west virginia medicaid provider manual for coverage determination. Community plan care provider manuals for medicaid plans by.
Please make a selection for the linkdocumentation desired. Medicaid dme and supplies listing wheelchairs and accessories. Medicaid is an insurance program for americans with low incomes and usually limited assets, primarily the elderly or disabled but also some adults and children. Molina healthcare updates and publishes the provider manual once a year. For information on ncci as it applies to medicaid, click here. Youll find most of the information you need in the provider manual. Subpart bearly and periodic screening, diagnosis, and treatment epsdt of individuals under age 21 and screening requirements and recommendations set forth by the centers for medicare and medicaid services. Download a free copy of acrobat reader spring 2020 supplier manual full manual. Effective july 1, 2014 pharmacy prior authorization insourcing provider update. Provider manual with billing instructions for primary care providers. Due to concerns that some providers and suppliers may need additional time to establish operational protocols necessary to comply with facetoface encounter requirements mandated by the affordable care act aca for certain items of durable medical equipment dme, cms will start actively enforcing and will expect full compliance with the dme. Dme supplies required to be billed through the pharmacy system pdf 2014 archived fee schedules. In addition to the items above, the following information is available.
Nonemergency care provided outside of west virginia without approval from umr is not covered. Provider manuals georgia department of community health. These manuals are not exhaustive of medicaid law and should not be relied upon as a legal authority. Provider manual this manual provides physicians, hospitals, and other healthcare practitioners in the health plan network with an easytouse guide to our business and medical management practices. Please reference rental versus purchase guidelines in chapter iv of this provider manual for additional requirements. This manual is a comprehensive guide for texas medicaid providers. Healthcheck provider manual large file, 3 pages the provider manual content is based on 42 c. You can navigate to specific sections of the manual in the table of contents. The manual is regularly updated to reflect the most recent policy and procedure changes. Updates are generally available the month following the effective date of the change. This manual does not address all the complexities of medicaid policies and procedures, and must be supplemented with all state and federal laws and regulations. Complete list sorted by hcpcs code pdf wheelchair only listed by hcpcs code pdf 20 archived fee schedules. 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.
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