Substance Use Disorder (SUD) Waiver Services to be covered by Managed Care Organizations (MCOs) beginning July 1, 2019!

6/26/2019

​On July 1, 2019, all Substance Use Disorder (SUD) Waiver services, except for Opioid Treatment Programs (Methadone), will be covered by Medicaid Managed Care Organizations (MCOs) for their members. SUD providers will receive prior authorizations for services from and submit billing for services to the MCOs for members enrolled within their health plan. All SUD providers should prepare for this upcoming transition by ensuring they are enrolled and credentialed with the MCOs below:

MCO Claims and Authorizations:
Aetna - 1-888-348-2922  or 1-888-348-2922 
 www.aetnabetterhealth.com/wv
The Health Plan - 1-888-613-8385  1-877-847-7901
 www.healthplan.org
UniCare - 1-800-782-0095  or  1-800-782-0085  
www.unicare.com/medicaid

SUD providers for Medicaid members who are not enrolled in an MCO will continue to submit request for authorizations and claims through the fee-for-service program.

Fee-For-Service Claims and Authorizations:
DXC Technology
1-888-483-0797 or 1-888-483-0793
 www.wvmmis.com
KEPRO
1-800-378-0284  
 http://wvaso.kepro.com/members/

Click here to access Chapter 504, Substance Use Disorder Services (the SUD Waiver Manual)

For authorizations that are approved beyond June 30, 2019 from KEPRO, providers will be required to submit claims for dates of service prior to July 1st to DXC.  Services from July 1st and beyond will be required to be submitted to the member's MCO.



Contact Information

For more information, please contact the BMS at 304-558-1700.
350 Capitol Street | Room 251 | Charleston, WV 25301 | Phone: (304) 558-1700 | Contact Us | Site Map