Provider Notice!
Effective July 1, 2023, the West Virginia Children's Health Insurance Program (WVCHIP) will also cover the same Medicaid benefits that are provided to children and pregnant women under the Medicaid State Plan. The amount, duration, and scope of services, including any authorization requirements, established in Medicaid policy will apply to WVCHIP members in the same manner. The policies contained in the BMS Provider Manual will apply to WVCHIP unless an exclusion policy is noted.
WVCHIP Provider Notice
Important Notice!
Due to the World Health Organization declaring Coronavirus disease (COVID-19) a pandemic, the West Virginia Bureau for Medical Services (BMS) has expanded certain services and waived certain requirements that may be listed in the Medicaid Provider Manual. Please refer to the COVID-19 Alerts and Updates page for specific changes and updates.
Please be advised that the West Virginia Medicaid Provider Manual does not address all the complexities of Medicaid policy and procedures and must be supplemented with all Federal and State Laws and Regulations. Billing instructions can be found on the Molina Medicaid Solutions website at: http://www.wvmmis.com.
Important Notice: Effective October 1, 2010, states were required by the Centers for Medicare and Medicaid Services (CMS) to incorporate all National Correct Coding Initiative (NCCI) methodologies into their systems for processing Medicaid claims. The following chapters of the BMS Provider Manual will be updated on an ongoing basis to reflect this requirement. Until all chapters are updated, this notice serves to inform providers that the required NCCI methodologies supersede any language in the BMS Provider Manual chapters as it relates to coding and/or the processing of claims submitted for services provided to WV Medicaid members.
For information on NCCI as it applies to Medicaid, click here.
Policy Manuals by Chapter
Chapter 100 - General Information Effective March 1, 2023
Chapter 200 - Definitions and Acronyms Effective November 1, 2016
Chapter 300 - Provider Participation Requirements Effective May 18, 2018
Chapter 400 - Member Eligibility Effective April 1, 2022
Chapter 501 - Aged & Disabled Waiver Effective May 1, 2023
Chapter 502 - Children with Serious Emotional Disorder Waiver Effective July 1, 2021
Chapter 503 - Licensed Behavioral Health Centers Effective
July 15, 2018
Chapter 504 - Substance Use Disorder Services Effective January 1, 2023
Chapter 505 - Oral Health Services Effective January 1, 2021
Chapter 506 - Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Effective October 1, 2015
Chapter 507 - Ambulatory Surgical Center Effective September 16, 2015
Chapter 508 - Home Health Effective December 21, 2018
Chapter 509 - Hospice Services Effective May 1, 2020
Chapter 510 - Hospital Services Effective January 1, 2024
Chapter 511 - Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Effective July 1, 2022
Chapter 512 - Traumatic Brain Injury (TBI) Waiver Effective August 1, 2023
Chapter 513 - Intellectual Developmental Disabilities (I/DD) Waiver Effective December 21, 2023
Chapter 514 - Nursing Facility Services Effective July 1, 2020
Chapter 515 - Occupational/Physical Therapy Effective Date July 1, 2019
Chapter 516 - Reserved
Chapter 517 - Personal Care Services Effective January 1, 2018
Chapter 518 - Pharmacy Services Effective March 16, 2023
Chapter 519 - Practitioner Services Effective February 1, 2018
Chapter 520 - Reserved
Chapter 521 - Behavioral Health Outpatient Services Effective January 15, 2018
Chapter 522 - Federally Qualified Health Center and Rural Health Clinic Services Effective July 1, 2019
Chapter 523 - Targeted Case Management Effective July 1, 2016
Chapter 524 - Transportation Effective September 1, 2020
Chapter 525 - Vision Services Effective April 1, 2023
Chapter 526 - Children with Disabilities Community Services Program Effective June 1, 2015
Chapter 527 - Mountain Health Trust (Managed Care) - Effective November 1, 2020
Chapter 528 - Radiology Services Revised May 24, 2019
Chapter 529 - Laboratory Services Effective April 1, 2023
Chapter 530 - Speech and Audiology Services Effective October 1, 2015
Chapter 531 - Psychiatric Residential Treatment Facility Services Effective January 1, 2023
Chapter 532 - Private Duty Nursing Effective May 1, 2020
Chapter 533 - Birthing Center Services Effective September 16, 2015
Chapter 534 - Dialysis Centers Effective May 31, 2019
Chapter 535 - Health Homes Effective April 1, 2017
Chapter 537 - Licensed Independent Clinical Social Worker (LICSW) The policies in this chapter are now covered in Chapter 521
Chapter 538 - School Based Health Services
Chapter 539 - Local Health Departments Effective October 1, 2023
Chapter 540- Neonatal Abstinence Syndrome Center Services Effective June 12, 2019
Chapter 600 - Reimbursement Methodologies
Chapter 700 - West Virginia Clearance for Access: Registry & Employment Screening (WV CARES) Effective July 1, 2018
Chapter 800 - Program Integrity Effective August 1, 2023
Chapter 900 - Estate Recovery Effective October 2, 2015
Chapter 1000 - Quality Assurance Effective September 1, 2020
Provider Manual Archive