Provider manual aetna better health of west virginia. Florida workers compensation health care provider reimbursement manual 2016 edition page 10 effective date. 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. Medicaid rehabilitation option services overview medicaid rehabilitation option mro services are designed to assist in the rehabilitation of the. Kidstrong conference school nursing medicaid presentation june 22, 2016 pdf. The following documents comprise the michigan medicaid provider manual and. Policy and procedures manual west virginia department of. Module 1 occupational therapy billing form updated august 2017. July 1, 2017 chapter 1 introduction and overview, continued administrative purpose of the manual the administrative purpose of the florida workers compensation. 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. One good way to keep them healthy is making sure they get medical care. As an aetna better health of west virginia provider, there are certain procedures and protocols you need to know. Medicaid coverage for transitionrelated care no updates required since november 21, 2019. The ssirelated medicaid programs fact sheets provides only brief information.
Decision it is the decision of the state hearing officer to uphold the departments decision to deny. Wv medicaid physicians rbrvs fee schedules wv dhhr. Please refer to the appropriate west virginia medicaid provider manual for coverage determination. Nd medicaid ambulance provider fee schedule 712017 nd medicaid ambulatory surgical center asc fee schedule.
Bms has a joint goal with medicaid enrolled providers to ensure effective services are provided to medicaid members. Bms provider manual page 1 chapter 519 practitioner services revised 1152016. Medicare provider reimbursement manual medicare add. State medicaid policy explicitly covers transitionrelated health care. 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. For dates of service from january 1, 2014, through june 30, 2021, the ihcp implemented a 3% reduction in reimbursement for inpatient and outpatient hospital services. 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. You, your employees, the organization you have the authority to represent and it employees and agents are authorized to use the cpt and cdt only as contained in the following authorized materials of the center for medicare and medicaid services cms internally within your organization within the united states for the sole use by yourself, your. Any service, procedure, item, or situation not discussed in the west virginia provider manual must be presumed noncovered unless informed otherwise, in writing, by the west virginia bureau for.
Wv medicaid encourages providers to render services via telehealth in the behavioral. Chapter 1 welcome to aetna better health of west virginia 9. Medical policies and clinical utilization management guidelines update. Wvchip was created to help working families who do not have health insurance for their children. P a g e e ga early and periodic screening, diagnosis and. West virginia state telehealth laws and reimbursement policies. 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. West virginia medicaid covers and reimburses a limited number of telehealth services that are provided. Type name modified file size wv medicaid newsletters 2020 352020 4. At lower income levels, families may be eligible for wv medicaid. Medicaid enrolled providers should give priority to children that have been identified as being in the foster care system.
The bureau for medical services bms is the single state agency. Wv state plan amendment 1125 2014 state plan amendment effective 71 2014. Provide professional, individualized and comprehensive care. D payment for drugs for beneficiaries enrolled in hospicefinal 2014 guidance. 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. Abhwv provider manual 20182019 aetna better health. Medicaid eligibility is determined based on income and other factors, depending on your eligibility category. If youre a provider of unicare health plan of west virginia, inc. West virginia medicaid population for the west virginia family health plan. Durable medical equipment and medical supply services provider fee schedule for all medicaid recipients. You also can call our community resource center tollfree at 18886119958 and speak with our staff dedicated to serving our providers. 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. Medicaid billing changes west virginia department of. West virginias medicaid telehealth policy is based.
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. Questions regarding medicaid eligibility, provider enrollment, status of claims or other billing. The following is the list of available options within this category. To find the contact information for your provider advocate, go to find a network contact, and then select your state. Pharmacy provider manual 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. Please refer to the appropriate west virginia medicaid provider manual for. This provider manual along with various tools and reference materials are available at. Medicaid rehabilitation option mro provider manual library reference number. Aetna is the brand name used for products and services provided by one or more of the aetna group of. Aetna medicaid also provides medicaidrelated administrative services to new hampshires medicaid program. Beginning january 1, 2014, wv medicaid copayment amounts for eligible members are based on the following.
For purposes of medicaid, telemedicine seeks to improve a patients health by permitting twoway, real time interactive communication between the patient, and the physician or practitioner at the distant site. Macpac report to congress on medicaid and chip march 2018. Dental health is an important part of peoples overall health. Table of contents west virginia department of health and. The program policy was established in wv medicaid chapter 535 and utilized to establish kepros utilization guidelines. November, 2014 policies and procedures as of june 1, 2014 version. Fee for service as of july 1, 2017, pharmacy services for west virginia family. See west virginia medicaid provider manual, ch 100 since at least 2005 wisconsin.
Medicaid eligibility in west virginia medicare pdf list. Providers must ensure services are delivered in accordance with the medicaid service provider manual and. Your guide to west virginia medicaid west virginia department of. West virginia medicaid health homes provider manual. The allowed amount for each detail line of outpatient and outpatient crossover claims is calculated. In 2017, nearly all states and the district of columbia provided some. 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.
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. If you need an older version of an administrative guide or care provider manual, please contact your provider advocate. 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. Map has tracked state medicaid policies since at least 2017. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment. Policy and procedures manual october 2017 empowering families for healthy beginnings mission statement. The bms has a joint goal with medicaid enrolled providers to ensure effective services are provided to medicaid members. Please be advised that the west virginia medicaid provider manual does not address all the. Download adobe acrobat reader to open and read pdf documents from this site. Centers for medicare and medicaid services, february 2014. Services in the medicaid program administered by the west virginia department of health and human resources wvdhhr under the provisions of title xix of the social security act and chapter 9 of the public welfare law of wv. West virginia department of health and human resources, bureau for medical services began planning the implementation of health homes in 2011. 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. Wv medicaid physicians rbrvs fee schedules page content disclaimer.
See minnesota provider manual 2017 guidance, brought about by 2016. On october 10, 2017, the centers for medicare and medicaid services cms approved a medicaid section 1115. Your 2017 guide to medicaid west virginia department of health. The detailed summary of provider manual changes contains all detailed changes made to this provider.
Nh medicaid final vision provider billing manual at. 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. School based health services medicaid policy manual. Promulgated fee schedule 112019 promulgated xls 112019 updated fee schedule 112020. Please make a selection for the linkdocumentation desired. 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. 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. West virginia family health wvfh provider manual pdf west virginia family health wvfh behavioral health provider manual pdf scion dental provider. Please refer to the covid19 alerts and updates page for specific changes and updates. Ten states have enacted telemedicine parity laws since the initial report in 2014. 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. Kidstrong conference school nursing medicaid presentation june 22, 2016. The following chapters of the bms provider manual will be updated on an ongoing basis to.
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