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.  

NEW!!!!

• CareConnection BH System Blackout Notice 
• BH Atrezzo Revised Go-Live date
• Atrezzo Provider Portal Administrator Training Module 1 Announcement
• Atrezzo Provider Portal Auth Submission Training Module 2 Announcement
  

• Data Submission information and instructions
  • ANG Provider Portal User Guide

• ANG Provider Portal Quick Reference Guides
• How to add Chrome Browser
• How to view determination letter
• How to complete a saved request
• Adding a Temporary Consumer
• How to add NPI to existing account
• Atrezzo MFA process for existing users
• Instructional Videos
• UM Provider Portal Enhancement-Action Items Demonstration
• How to submit a BH request 
• Atrezzo Provider Portal EDI Systems Training

Behavioral Health Services - Provider Enrollment Registration

• • ANG Provider Portal Administrator Registration Training
  • ANG Provider Client MFA Registration Process 

• • How to add a User
  • How to update a User profile
  • How to Reset Password or Unlock Account
  • Provider ADMIN Registration Training Video 
  • Provider ADMIN - ADD and MANAGE Users Accounts Training Video
  • WV Medicaid and WVCHIP Behavioral Health Master Code List(MCL) 2023

Behavioral Health Manuals and instructions

Behavioral Health Provider Utilization Management Guidelines

• BH Submission and Timelines
• BH Leniency Process
• Out-of-state Provider Utilization Management Guidelines
• High Intensity Services Provider Utilization Management Guidelines
• Licensed Independent Clinical Social Workers Utilization Management Guidelines
• Clinic/Rehabilitation/TCM Utilization Management Guidelines
• Psychiatric Services Utilization Management Guidelines
• Psychological Services Utilization Management Guidelines
• FQHC & RHC Utilization Management Service Guidelines

Behavioral Health Provider Manuals and Instructions

• Behavioral Health Provider Manual
• Instructions for Completing CareConnection® High Intensity (tiered)
• Instructions for Completing the CareConnection® for Private Practitioners (tiered)
• Instructions for Completing CareConnection® for FQHC and RHC (tiered)
• Instructions for Completing CareConnection® for Clinic, Rehabilitation and TCM Providers (tiered)
• Instructions for Completing CareConnection® for Clinic, Rehabilitation and TCM Providers (numeric)
• WV Medicaid Staff Requirements for Covered Services - FQHC and RHC
• WV Medicaid Staff Requirements for Covered Services - LBHC
• WV Medicaid Staff Requirements for Covered Services - Private Practice

Behavioral Health Retrospective Review Tools

Licensed Behavioral Health Center Tools

• Assertive Community Treatment
• Behavioral Health Counseling Professional
• Behavioral Health Counseling Professional Group
• Behavioral Health Counseling Supportive
• Behavioral Health Counseling Supportive Group
• Community Psychiatric Supportive Treatment
• Comprehensive Community Support
• Crisis Intervention
• Day Treatment
• Developmental Testing Limited
• Group Therapy - Focused
• Intensive Services
• LBHC Organizational Tool
• Mental Health Assess by Non-Physician
• Medication Assisted Treatment
• Peer Recovery Support Services
• Psychiatric Diagnostic Interview
• Psychiatric Diagnostic Interview with Medical Evaluation
• Psychological Testing Tool
• Psychotherapy - Focused
• Residential Services -SUD
• Residential Children's Services - Level I and II Services
• Residential Children's Services - Level III
• Residential Children's Services - Level IV
• Screening by Licensed Psychologist
• Skills Training and Development
• Targeted Case Management
• Therapeutic Behavioral Services Development
• Therapeutic Behavioral Services Implementation
• WV ACT Fidelity Factors

 Private Practice Services Tools

• Biofeedback Psychotherapy
• Crisis Psychotherapy
• Developmental Testing by Professional
• Developmental Testing Limited
• Diagnostic Interview Tool Psychiatrist
• Family Psychotherapy
• Group Psychotherapy
• Individual Psychotherapy
• Psychiatric Diagnostic Interview with Medical Evaluation
• Mental Health Assessment by Non Physician
• Medication Assisted Treatment Tool
• Neuropsychological Testing
• Neuropsychological Testing Automated Results
• Private Practice Organizational Tool
• Psychological Testing

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

• Prior Authorization Service Request for Behavioral Health Services
• 2021 CareConnection® Web Application User’s Manual
• Accessing Medical Response Files Instructions
• Prior Authorization Service Request Instructions
• Prior Authorization Request for Medical Services Data Elements/Layout
• EDI Submissions Manual
• BHS CareConnection® Provider to Kepro File Layout
• Medication Domain Values
• BHHF Data Segment Import File Layout
• Consumer Service Data Report File Layout from BHHF Contract Providers to KEPRO
• Kepro Instructions for Completing the BBHHF CSDR
• BBHHF Data Segment BDS Provider to Kepro Drug Codes for File Layout

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 Kepro at wv_bh_sns@kepro.com   or contact Kepro, WV Office at 304.343.9663.

• Behavioral Health Services Provider Registration Form - FQHC
• Behavioral Health Services Provider Registration Form - High Intensity
• Behavioral Health Services Provider Registration Form - LBHC
• Behavioral Health Services Provider Registration Form - LICSW/LPC
• Behavioral Health Services Provider Registration Form - CAC/DRC
• Behavioral Health Services Provider Registration Form - ABA
• Behavioral Health Services Provider Registration Form - Private Practitioners
• Behavioral Health Services Web User Request Form

 Behavioral Health Forms and Memos

• Data Collection forms for CareConnection®
  • CareConnection® Form for Core
  • CareConnection® Form for Core +
  • CareConnection® Form for Outpatient (tier 2)
  • CareConnection® Form for Risk Assessment
  • CareConnection® Form for Intensive Services
  • CareConnection® Form for High Intensity
  • CareConnection® Form for Offender Risk Assessment
  • CareConnection® Form for Assessment
  • CareConnection® Form for Discharge
• MCM – 1
• Behavioral Health Member Choice Form
• Authorization Adjustment Process
• Authorization Adjustment Request