Behavioral Health

The Behavioral Health Program is Kepro’s legacy program in West Virginia. Since late 2000, Kepro has provided prior authorizations for behavioral health services, retroactive provider documentation reviews, technical assistance and training to providers, data analysis and member focused activities. 

The Behavioral Health Program promotes coordination of services for West Virginia Medicaid Fee-for-Service members across payer sources and has expanded to include the following provider types offering behavioral health services to West Virginia Medicaid members:

  • Acute Psychiatric Inpatient Hospitals (for members under age 21 and adults),
  • Partial Hospitalization programs,
  • Psychiatric Residential Treatment Facilities (both in state and out of state),
  • Private Psychiatric and Psychological practitioners,
  • Licensed Behavioral Health Centers,
  • Federally Qualified Health Centers and Rural Health Clinics; and Rural Health Clinics,
  • Licensed Independent Clinical Social Workers, and
  • Licensed Professional Counselors

Kepro - West Virginia staff members in this program have extensive experience working in the West Virginia behavioral healthcare system and all clinical staff members are fully licensed in West Virginia. Additional services provided by Kepro include:

  • Training and technical assistance
  • Retrospective care reviews
  • Data analysis and reporting
  • Quality Improvement activities
  • Interagency consultation and collaboration

The state of West Virginia Department of Health and Human Resources Bureau for Medical Services utilizes the following definition of behavioral health, services and supplies that are:

  1. Appropriate and necessary for the symptoms, diagnosis or treatment of an illness
  2. Provided for the diagnosis or direct care of an illness
  3. Within the standards of good practice
  4. Not primarily for the convenience of the plan member or provider
  5. The most appropriate level of care that can be safely provided

To learn more, visit West Virginia Department Health and Human Resources website at http://www.dhhr.wv.gov/.

For a listing of licensed behavioral healthcare providers in West Virginia, visit the West Virginia Bureau for Medical Services’ website at http://www.dhhr.wv.gov/bms.  

 

Behavioral Health Manuals and instructions

Behavioral Health Provider Utilization Management Guidelines

Behavioral Health Provider Manuals and Instructions

Behavioral Health Retrospective Review Tools

Outpatient Consultation Tools

 Private Practice Services Tools

NEW***Behavioral Health Monthly Webinars

  1. Psychological Testing Presentation (April 2019)
  2. TCM Webinar Presentation (May 2019)
  3. Assessment Presentation (June 2019)
  4. Professional Therapy Presentation (July 2019)
  5. SUD Waiver RAS Application Presentation (August 2019)
  6. Skills Training and Development
  7. Service Planning Oct 2019
  8. Behavior Management 2019
  9. SIC Webinar Nov 2019

 

Health Data Submission information and instructions

 

Forms and Enrollment

Behavioral Health Services - Provider Enrollment Registration

Providers must be enrolled with the Bureau for Medical Services (BMS) to provide clinic, rehabilitation, targeted case management, private practice psychiatric or private practice psychological services as well as Bureau for Behavioral Health and Health Facilities (BHHF) contract providers are required to submit data to Kepro to receive prior authorization for services. Providers may submit either directly via the Kepro website or through EDI submission. Providers must register with Kepro. To register, contact Harry Cook at hcook@kepro.com  or contact Kepro at 304.343.9663.

 Behavioral Health Forms and Memos