Medical Services

New****West Virginia is transitioning to a new web platform for Medical Services called Atrezzo effective 02/01/2022.  Please click here for further information.

Atrezzo Next Generation (ANG) for Medical Services-Provider Portal 

Beginning February 1, 2022, entities seeking approval for medical services will utilize Atrezzo Next Generation (ANG) to submit prior authorization requests.  Atrezzo Next Generation (ANG) supports the entire WVCHIP Medical process for clinical determination of services.

Data Submission information and instructions

• ANG Provider Portal User Guide
• UM Case View Enhancement Demonstration
• ANG Provider Portal Quick Reference Guides
  • How to add supporting documentation
  • How to add Chrome Browser
  • How to view determination letter
  • How to complete a saved request
• Instructional Videos
  • Adding a Temporary Consumer
  • Submitting Inpatient Request 
  • Submitting Outpatient Request 
  • Submitting from Consumer  
  • Searching for Determinations
  • Submitting Copy for Correction
  • Submitting copy for new submission
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• WVCHIP MCL - Master Code List-2022 

WVCHIP - Provider Enrollment Registration

• ANG Provider Client MFA Registration Process
• ANG Provider Portal Administrator Registration Training
  • 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 Provider Registration FAQs (will be added once document is finalized after all trainings)

 WVCHIP Medical Services

Atrezzo Next Generation (ANG) System Information

• Instructions for Copy for New Submission 
• Instructions for Copy for Correction 
• Frequently Used Numbers
• WVCHIP MCL - Master Code List-2022 

• Medical Services Forms and Memos

• WVCHIP Prior Authorization Modification Request Form
• WVCHIP - WV CareConnection®Fax Cover
• Dental Services
• Dental Services Prior Authorization Request Form
• WVCHIP Orthodontic Criteria
• WVCHIP Dental 2019
• Durable Medical Equipment (DME)
• DME Prior Authorization Request Form
• Home Health
• Home Health Services Prior Authorization Request Form
• Hospice
• Hospice Services Prior Authorization Request Form
• Inpatient Services - Acute Hospital & Inpatient Rehabilitation <21
• Inpatient Prior Authorization Request Form
• Inpatient Rehab Prior Authorization Request Form
• Lab/Radiology/Imaging
• Lab/Radiology/Imaging Prior Authorization Request Form
• Orthotic and Prosthetic Services
• Orthotic/Prosthetic Services Prior Authorization Request Form
• Outpatient Services over Service Limit
• OutPatient Services over the Service Limit Office Consult Form
• Out-of-Network Services (WVCHIP Non-Enrolled Providers)
• Out-of-Network Prior Authorization Request Form
• Outpatient Surgery Services
• Outpatient Surgery Prior Authorization Request Form
• Podiatry
• Podiatry Prior Authorization Request Form
• Private Duty Nursing
• Private Duty Nursing Prior Authorization Request Form
• Therapeutic and Rehabilitation Services
• Pulmonary Rehab Prior Authorization Request Form
• Cardiac Rehab Prior Authorization Request Form
• Chiropractic Prior Authorization Request Form
• Speech Prior Authorization Request Form
• Audiology Prior Authorization Request Form
• PT/OT Prior Authorization Request Form
• Transportation Services
• Transportation Prior Authorization Request Form
• Vision
• Vision Form – Under 21 - Prior Authorization Request