Attention West Virginia Medicaid providers!
The COVID-19 testing coverage for non-insured patients will terminate on May 11, 2023 and all claims for date of service on or before May 11, 2023, must be submitted before August 11, 2023 to be covered by West Virginia Medicaid.
- For questions or assistance for a Member enrolled with Fee-for-service Medicaid, Providers can contact Gainwell Technology at 1-800-483-0793 or wvmmis@gainwell.com
- For questions or assistance for a member enrolled with a Medicaid Managed Care Organization (MCO), Providers should contact the member’s designated MCO.
This coverage provides limited services related to the testing and diagnosis of Coronavirus (COVID-19) and outpatient prescription drug treatment. Testing related services do not include services for treatment of COVID-19.
Who can qualify for COVID-19 Testing Coverage?
You may qualify for COVID-19 testing coverage if:
- You are a West Virginia resident
- You are a U.S. citizen, U.S. national, or eligible immigrant
- You are uninsured:
- Not eligible for full West Virginia Medicaid or the West Virginia Children's Health Insurance Program
- Not enrolled in another health care program funded by the federal government such as Medicare or Tricare
- Not enrolled in a group health plan, private health plan, or other employer-based health insurance coverage.
There is no income or asset test, however an attestation regarding uninsured status is required.
The Application for COVID-19 Testing Coverage permits applicants to verbally designate a provider as an authorized representative for purposes of signing and submitting the application. You may not act as authorized representative unless affirmatively designated by the applicant/patient. The consent form to complete and submit along with the COVID-19 Testing Coverage application is available for download below.
To verify the applicant’s verbal consent to appoint you as an authorized representative:
1. Ensure that an authorized representative form is filled out in its entirety,
2. Review the entire document verbally while on the telephone with the patient,
3. Write the patient’s name on the signature line with a notation that consent was obtained via phone due to COVID-19 precautions,
4. Document the time and date of the call on the form, and
5. Provide the authorized representative consent form with the signed application.
If you are sick and suspect that you may need testing for COVID-19, you should seek immediate medical attention for evaluation. You can do this by making an appointment with your regular physician, or by seeking care at an urgent care facility or the nearest hospital emergency room.
To download the Authorized Representative Form-Appendix C, please
click here. To download an application, please
click here. Para bajar la versión en espaňol, haga
click aqui.