| Providers
do not have to be a “member”
of WVCHIP to provide services
to a child who has health
coverage through CHIP. They
only need to accept the reimbursement amount
provided by CHIP.
HealthCheck for all West Virginia Children
ACORDIA NATIONAL CHANGES NAME TO WELL'S FARGO - Click here for more information.
Express Scripts, Inc. is the pharmacy benefits manager
New Identification Numbers For WVCHIP Member Cards
In response to concerns about Social Security Numbers on member ID cards, WVCHIP has developed an Alternate ID number for WVCHIP Plan members. These numbers appear on the ID cards mailed to all members since October 1, 2006.
Providers can submit claims using either the new ID number or the social security number. Both the medical and the prescription drug claim systems can accept either identifier.
New Preferred Drug List for WVCHIP members
The West Virginia Children’s Health Insurance Program has updated the Preferred Drug List (PDL), effective January 1, 2008. Click here for the new preferred drug list.
Due to rising drugs costs a new drug list was created in 2006, by focusing more on generic use to contain costs. Adoption of this change is estimated to bring a total savings of more than $1 million to the program. Unlike the past PDL's, non-preferred drugs will no longer be covered. After January 1, 2006, if a provider chooses to prescribe a drug not listed on the formulary it will be a 100% retail cost to the patient. Co-payments for drugs on the new PDL will remain the same. Questions concerning drugs covered by WVCHIP should be directed to Express Scripts, Inc. (ESI) at 1-877-256-4689. Click here to see a copy of the letter mailed out to WV CHIP families.
Reimbursement
Health care providers are
reimbursed according to the
maximum schedule and rates
established by WVCHIP. If
a provider’s charge
is higher than the WVCHIP
maximum fee for a particular
service, the Plan will only
allow the maximum fee. The
“allowed charge”
for a particular service will
be the lesser of either the
provider’s charge or
the WVCHIP maximum fee. Physicians
and other health care professionals
are paid accordingly to a
Resource Based Relative Value
Scale (RBRVS) fee schedule.
Providers can check the PEIA
website at www.wvpeia.com
for specific procedure codes
covered under the WVCHIP Plan.
The WVCHIP plan is governed
in part by the Omnibus Health
Care Act enacted by the West
Virginia Legislature in April
1989. This law requires that
any health care provider who
treats a WVCHIP benefit plan
cardholder must accept assignment
of benefits. Plan cardholders
cannot be billed for any balance
of charges over and above
the WVCHIP fee allowance or
any discount amount applied
to the provider’s charge
or payment.
Treasurer's Office Now Writes WVCHIP Checks.
Click here for more information.
Electronic Claims Submission
Providers may bill WVCHIP electronically through Well's Fargo using several services.
Click here for more information.
Accessing Claim and Eligibility Information Online
You can check claim status and verify eligibility online at Well's Fargo website. Read more for instructions.
Click here for more information.
Rational Drug Therapy Program Now Reviews Prior Authorization Drug Requests.
Click here for more information.
Common Specialty Medications
Beginning July 1, 2005, WVCHIP selected CuraScript as the exclusive pharmacy for Common Specialty Medications. Click here for more information.
How does my office
verify CHIP eligibility?
How does my office
file a medical claim for a
WVCHIP patient?
What does my
office need to do if we dispute
a reimbursement claim?
Do WVCHIP members
have copayments for medical
services?
Does my office
have to precertify any medical
services for a WVCHIP patient?
What do I need
to do if I have to send a
CHIP patient out of state
for a medical procedure?
Who do I call
about prescription drug coverage?
What’s
New to WVCHIP?
How can my office
promote WVCHIP?
Who do I call to preauthorize prescription drug coverage?
Q. How does my office
verify CHIP eligibility?
A. By calling our toll-free
helpline at 1-877-WVA-CHIP
for eligibility verification
on the date of service remains
our best eligibility verification
mechanism at present.
Well's Fargo is an additional
resource that providers can
use to check the status of
a claim and verify eligibility.
Each provider will self-register
online for this service at
www.wellsfargo.com/tpa.
Also, Well's Fargo’s
fax back service allows the
provider to bypass speaking
to a customer service representative
when calling to verify eligibility
and copayments. Contact Well's Fargo at 1-800-356-2392
for more information.
Q. How does my office
file a medical claim for a
WVCHIP patient?
A. Providers must use the
standard CMS (Formerly HCFA) 1500 Claim Form
to request reimbursement for
services. Claims for all medical,
dental and vision services
should be forwarded to:
Well's Fargo
PO Box 2451
Charleston, WV 25329-2451
Q. What does my office
need to do if we dispute a
reimbursement claim?
A. Providers are requested
to first fully review any
disputed claims amount or
denial with Well's Fargo,
the claims administrator,
at 1-800-356-2392. Any provider
still wishing to dispute the
amount or denial of reimbursement
may file an appeal in writing
to:
WVCHIP
Attention: Executive Director
1018 Kanawha Blvd, East
Suite 209
Charleston, WV 25301
Q. Do WVCHIP members
have copayments for medical
services?
A. Yes, some plan members
have copayments for certain
medical and prescription services.
Click here for copayment
information.
Q. Does my office
have to precertify any medical
services for a WVCHIP patient?
A. Yes. Providers must contact
Well's Fargo at 1-800-356-2392
for precertification (of the service and where the service will take place) prior
to a WVCHIP cardholder’s
admission to a hospital, skilled
nursing facility, any other
inpatient facility and the
medical services listed below:
Abortion, Allergy Testing,
Arthroscopy (knee only), Cataract
Surgery, Chiropractic Care
and Treatment, Colonoscopy,
Day Programs, Durable Medical
Equipment (purchase or rental),
Home Health Care, Hospice
Care, Laparoscopy, Magnetic
Resonance Angiography (MRA), Occupational Therapy,
Pain Management Services,
Partial Hospitalization, PET
Scan, Septoplasty (with or
without Adenoidectomy), Vision
Therapy and Emergencies.
*If the admission is an emergency,
then a parent, guardian, family
member, provider or other
designated person must call
Acordia National at 1-800-356-2392
within 48 hours of the admission,
even if the child is discharged
in less than 48 hours. Remember,
for out-of-state care, the
parent or guardian must contact
Well's Fargo for prior
approval.
Q. What do I need
to do if I have to send a WVCHIP
patient out of state for a
medical procedure?
A. Well's Fargo uses three
networks for services outside
of West Virginia. In the State
of Ohio, the network is Medical
Mutual of Ohio’s SuperMed
Plus Network. For all other
states, Alliance and Beech
Street networks are used. WVCHIP cardholders
using an out-of-state provider
must get prior approval
from Acordia to ensure that
their claim will be paid.
Should they need assistance
locating a network provider,
they can call Well's Fargo
at 1-800-356-2392. If they
have access to the Internet,
provider information can be
obtained by visiting these
websites: Medical Mutual of
Ohio, Beech Street and Alliance.
Q. Who Do I Call About
Prescription Drug Coverage?
A. Contact Express Scripts,
Inc. at 1-877-256-4680 or
visit them online at
www.express-scripts.com.
Click here for the latest
drug
formulary.
Q. Who do I call to preauthorize prescription drug coverage?
A.
Contact WVU's Rational Drug Therapy Program at 1-800-847-3859.
For more information about
benefits, please review the Summary
Plan Description Plan and Provider
Guide. Click here to view WVCHIP's Notice of Privacy Practices.
Provider Outreach
As a provider you see patients
everyday with out health care.
You can help promote WVCHIP
by having materials available
in your waiting area and counseling
patients about insurance opportunities
during an office visit. Complete
a provider outreach
order form to start your
outreach efforts today.
Provider Publications
Provider Guide
Preferred Drug List
CPT Codes for Immunizations
Immunization Schedule for Ages 0-6 years
Immunization Schedule for Ages 7-18 years
Dental Care Flyer
Vision Care Flyer
Well-Child Exam Flyer
Child Development Flyer
Hearing Screening Flyer
Healthcheck Forms
Kindergarten Screening Document
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