WV CHIP Update -Important Information
As of January 1, 2016, the West Virginia Children's Health Insurance Program (WVCHIP) is using Molina to process claims.
All WVCHIP providers are required to enroll and provide credentialing. If you have not done so, or if you have submitted incomplete information, BMS is unable to process your claims.
There are issues with some provider files which are expected to be resolved in the next 30 days. If you are having difficulty with claims payment, please let BMS know by emailing
NOTE: Prior Authorization requests are still to be submitted to HealthSmart.
Although WVCHIP is now a division of the West Virginia Department of Health and Human Resources, it still operates as the same program, with the same benefits and payment rates.
WVCHIP is not part of Medicaid or its managed care programs.
Providers can confirm eligibility for a patient without a member card through the provider tab on
. Membership may also be verified by the patient, who can print a temporary card through this website. Contact the WVCHIP Helpline at 1-877-982-2447 or Molina at 1-800-479-3310, if assistance is needed.
Highmark West Virginia News
Physicians were recently sent a communication from Highmark regarding a change in reimbursement for their ACA product. Highmark West Virginia has taken a measured approach to managing ACA fees with an aggregate adjustment (reduction) of 0.6 percent for ACA direct-pay products.
Effective May 1, 2016, Highmark will adjust the provider fee schedule to implement new fees for their ACA individual (direct-pay) products.
Current fees are available in NaviNet®, and the ACA fees will be viewable in the system on or before May 1, 2016. (For more information on accessing current fees in NaviNet, please see "Fees Available via NaviNet" below. If you don't yet have NaviNet, visit
to get access to the system.)
The Highmark mailing also included an addendum to memorialize the fee changes and other agreements relevant to Highmark West Virginia's ACA network and products. Physicians should retain this document with their contract records.
On or before May 1, 2016, practices will be able to access all applicable payment information online. Visit the Provider Resource Center (via NaviNet) and select Administrative Reference Materials, and then Fee Schedule Information. Please note that fees are not published on the public Provider Resource Center.
Questions regarding the new fees should be addressed to Highmark's Provider Resource Center.
Highmark West Virginia has also announced that the plan is doing business differently in 2016. You will no longer have an assigned Provider Relations representative, but are instead encouraged to utilize the plan's self-service options. Highmark encourages you to take advantage of the online and telephonic tools that the plan offers.
NaviNet should be utilized as the primary resource for inquiries related to West Virginia Family Health members. Questions that cannot be resolved through NaviNet functionality for these members should be directed to West Virginia Family Health Provider Services at 1-855-412-8002.
WVMGMA Regional Meetings
The West Virginia Medical Group Management Association (WVMGMA) has planned a series of statewide regional meetings in May. Ken T. Hertz, Principal Consultant with MGMA will be speaking on the topics of
Trends in Practice Management and
Setting a Vision for Your Practice. The meetings are free but
registration is necessary.
Below are the dates and locations for the regional meetings.
Please register with the contact person at least ten (10) days prior to the meeting you would like to attend.
Monday, May 23rd---Morgantown
Holiday Inn Morgantown - University Area
9:00am - 11:15am
Tuesday, May 24th---Parkersburg
Camden Clark Hospital
10:30am - 2:00pm
Wednesday, May 25th----Beckley
Mountain State Co-op
10:00am - 2:00pm
Thursday, May 26th----Teays Valley
9:00am - 11:15am
Charleston Chapter OMA Educational Meeting
The Charleston OMA Chapter will meet on Tuesday, April 12, 2016 at 11:00 AM for a luncheon presentation on
"ICD-10 Taming the Beast"by Jenny Pauley, CMC, CMOM, Billing Director with MediSys Practice Solutions.
The meeting will be held at Thomas Hospital's Education Center. Members may attend free with a $20.00 charge for non-members.