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NEW **Attention WV Medicaid FFS & WVCHIP Behavioral Health Providers – New Behavioral Health Prior Authorization Portal**
Please see the attached announcement regarding the new Behavioral Health Prior Authorization Portal for Kepro. *Note that the current policies associated and put into place by the Bureau for Medical Services will not change.*
Medical and Behavior Timelines and Leniency Announcement
NEW **Attention WV Medicaid Medical FFS Providers – New Medical Prior Authorization Portal**
Please see the attached announcement regarding the new Medical Prior Authorization Portal for Kepro. *Note that the current policies associated and put into place by the Bureau for Medical Services will not change.*
NEW **Attention WV Medicaid Medical FFS Providers**
Kepro is currently in the process of updating the Medical Provider contact listing. This update is to ensure Medicaid FFS Providers stay up-to-date with upcoming Kepro announcements and trainings. Please go to https://survey.alchemer.com/s3/6268630/Kepro-Medical-Provider-Contact-Information-Update and complete the contact form at your earliest convenience.
New***Attention Podiatry providers: BMS Podiatry Billing Codes Update:
Effective 04/01/2021, the specialty of Podiatry was added to the following HCPCS/CPT codes:
Adult Dental Providers- Additional Training Announcement NEW***
Behavioral Health Program Announcement
New** As of January 1, 2017, the Centers for Medicare and Medicaid Services (CMS) annual updates have resulted in changes to drug testing codes utilized by WV Medicaid. The Bureau for Medical Services (BMS) will follow the 2017 CMS coding guidelines for reporting drug testing procedures:
BMS policy requires a prior authorization for drug screenings performed for over the limit of 24 per calendar year. The HF modifier must continue to be included on all claims for these codes when related to substance abuse treatment (e.g. Suboxone).
The presentation on the 2017 Drug Testing Changes can be found here: 2017 Drug Codes Changes Webinar Presentation
New** The West Virginia Department of Health and Human Resources (WV DHHR) along with the Bureau for Medical Services (BMS) is pleased to announce West Virginia Licensed Professional Counselors (LPC) may enroll as Medicaid Providers beginning Mar 1, 2017. The following services have been approved by West Virginia Medicaid for LPCs to provide:
A draft manual is in development and will be posted on the BMS website for public comment in the near future. More information and registration guidelines will be posted as it comes available.
New** WV Medicaid has released documents pertaining to the Substance Use Disorder Waiver. As of July 1, 2018, Phase 1 and Phase 2 of the waiver are active. In addition to the announcement letter, adult residential rates are listed below along with the Peer Recovery memorandum. The link to enrolling in the Public LMS Course DHHR provides info on accessing the Peer Recovery Certification Webinar
NEW*** Can telehealth be utilized through a personal computer?
BMS’s response: Yes, as long as the individual’s personal computer has a VPN to the provider and the provider ensures that it is safe to render services through this modality for the member.
NEW*** Per the 2019 Current Procedural Coding Expert manual, codes 96101, 96111, 96118, and 96120 were closed effective December 31, 2018. WV Medicaid is adding the replacement codes for each closed service. In the interim, KEPRO will continue to accept the closed codes for prior authorization. While authorizations issued under the 96101, 96111, 96118, and 96120 with dates of service after December 31, 2018 will be accepted, they will not be billable to the claims payer. Authorizations will require adjustment when all codes have been updated. Further communication will occur when changes are finalized.
NEW*** FAQ - Frequently Asked Questions
Question: Can LICSW’s and LPC’s sign treatment plans for LBHC services?
**NEW** SUD Waiver Transition for WV Medicaid MCO Members
Effective July 1, 2019, Substance Use Disorder Waiver Services for WV Medicaid MCO members will be submitted directly to MCO’s. Below are details related to existing authorizations and submission timelines.
Medical Services Announcements
NEW*** The West Virginia Department of Health and Human Resources (DHHR) and Bureau of Medical Services (BMS) are pleased to announce the statewide expansion of the first West Virginia Health Homes Program serving members with bipolar disorder with at risk for Hepatitis B and/or C. This expansion, Health Homes 2, will begin in April 2017.
NEW*** Beginning April 2017, a new program, Health Homes Program 3, will be implemented to serve members with pre-diabetes, diabetes, or obesity, and at risk for anxiety and/or depression. This program will be piloted in the following 14 counties: Boone, Cabell, Fayette, Kanawha, Lincoln, Logan, Mason, McDowell, Mercer, Mingo, Putnam, Raleigh, Wayne and Wyoming.
NEW***Substance Use Disorder (SUD) Training
The Bureau for Medical Services is pleased to announce upcoming SUD training to be held in conjunction with the Spring Molina Provider Workshops. The SUD training will address components of the WV Medicaid SUD Waiver Manual including information on ASAM and residential levels of care. The SUD training will occur following the morning Molina Workshops. If you intend to participate in both trainings, please make sure you register for each one individually.
Complete the attached registration form and indicate which SUD training session you will attend, along with the number of attendees from your organization. Forms should be returned to the contact information located at the bottom of the page. Registration must be received by April 9, 2018.
You may review Chapter 504 - Substance Use Disorder Manual at this web address: http://dhhr.wv.gov/bms/Pages/Chapter-504-Substance-Use-Disorder-Services.aspx
For more information on the morning Spring Molina Provider Workshop, please visit the Molina Website at https://www.wvmmis.com or email the Molina Provider Field Representatives at WVProviderFieldRepresentative@molinahealthcare.com
2018 Spring Provider Workshop Registration link:
Newly Released Documents
Per BMS ATTENTION Policy Revision: DMEPOS Providers:
Dental Provider Announcement
Unlisted CPT code 41899
Effective October 1, 2019, all unlisted CPT/HCPCS codes require authorization regardless of the place of service. An updated Master Code list that includes these unlisted codes has been added to KEPRO’s provider website: http://wvaso.kepro.com.
When dental services are performed in a hospital setting, the facility will submit claims to BMS’ current claims vendor, DXC Technology, for the usage of the operating room with CPT code 41899. CPT code 41899 is an unlisted CPT code and prior authorization is now required. Dental Providers must fax an Outpatient (OP) surgery request form filled out in its entirety for clinical review to 844-633-8427. This fax number is also shown on the top of the request form. This must be done for all dental services performed in a hospital setting whether or not the dental procedure requires prior authorization. The dental procedure to be performed should be indicated on the request for 41899.
KEPRO’s DDE Provider portal does not have an option for a dental provider to submit an OP surgery request so requests for 41899 should be faxed. The faxed authorization request received will be keyed by KEPRO staff under the hospital facility. The requesting Dental Provider will not have access to these authorization requests. As a courtesy to Dental Providers, KEPRO staff will fax determinations to the fax number indicated by the Dental Provider on the request form for CPT code 41899 only. The process for Dental Providers to obtain authorization for dental services billed with CDT (dental) codes that require prior authorization has not changed.
For additional information, please access KEPRO’s provider website http://wvaso.kepro.com or contact KEPRO-Medical Unit at 800-346-8272 for assistance. Please see the attached letter sent at the request of the Bureau of Medical Services regarding rate reimbursement changes for Private Duty Nursing. Please direct questions to the Bureau for Medical Services.
***NEW PDN Rate Reimbursement: Please see the attached letter sent at the request of the Bureau of Medical Services regarding rate reimbursement changes for Private Duty Nursing. Please direct questions to the Bureau for Medical Services.
Attention Nursing Home Providers - Atrezzo Training Registration
Announcement re: Constitutional Amendment 1- on behalf of the West Virginia Bureau for Medical Services (BMS)
Below please find Public Notice information related to recently passed West Virginia Constitutional Amendment 1. The link for further information is: https://dhhr.wv.gov/bms/Public%20Notices/Pages/Public%20Notice%20regarding%20West%20Virginia%20Constitutional%20Amendment%201%20is%20now%20available.aspx
Also attached is the new certification form for your reference and use.
Public Notice regarding West Virginia Constitutional Amendment 1 is now available.
WEST VIRGINIA MEDICAID PROGRAM
REGARDING: WEST VIRGINIA CONSTITUTIONAL AMENDMENT 1
INITIALLY ISSUED: NOVEMBER 9, 2018
AMENDED: NOVEMBER 13, 2018
On November 6, 2018 West Virginia voters ratified West Virginia Constitutional Amendment 1, which states: “Nothing in this Constitution secures or protects a right to abortion or requires funding of abortion.” This amendment in turn abrogated the holding by the West Virginia Supreme Court in Women’s Health Center of West Virginia, Inc. v.Panepinto (1993) that West Virginia Code §9-2-11, which limits Medicaid funds paying for pregnancy terminations to several limited circumstances, is unconstitutional.
As a result of the ratification of this Constitutional Amendment as described above, effective November 6, 2018 at 7:30 PM, the West Virginia Bureau for Medical Services will only reimburse providers for pregnancy terminations in the following three circumstances, consistent with W. Va. Code §9-2-11:
If there are any questions, please contact the West Virginia Bureau for Medical Services at (304) 558-1700.