Policy Manual

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.

COMBINED CHAPTER SEARCH - ALL CHAPTERS
All Chapters  Chapters marked as new or updated below are not included in the All Chapters at this time.

INDIVIDUAL CHAPTER SEARCH - TABLE OF CONTENTS
Chapter 100 - General Information
Chapter 200 - Definitions and Acronyms Effective November 1, 2016
Chapter 300 - Provider Participation Requirements Effective May 19, 2018
Chapter 400 - Member Eligibility Effective April 1, 2020
Chapter 501 - Aged & Disabled Waiver Effective January 1, 2019
Chapter 502 - Children with Serious Emotional Disorder Waiver Effective March 1, 2020
Chapter 503 - Licensed Behavioral Health Centers Effective July 15, 2018
Chapter 504 - Substance Use Disorder Services   Revised July 1, 2019
Chapter 505 - Oral Health Services  Effective October 1, 2019
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
Chapter 511 - Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Effective June 6, 2016
Chapter 512 - Traumatic Brain Injury (TBI) Waiver  Effective January 1, 2019
Chapter 513 - Intellectual Developmental Disabilities (I/DD) Waiver  Effective February 1, 2018
Chapter 514 - Nursing  Facility Services
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 July 20, 2018
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 May 31, 2019
Chapter 525 - Vision Services  Effective June 1, 2016
Chapter 526 - Children with Disabilities Community Services Program  Effective June 1, 2015
Chapter 527 - Mountain Health Trust (Managed Care) - Effective April 1, 2018
Chapter 528 - Radiology Services Revised May 24, 2019
Chapter 529 - Laboratory Services  Revised July 1, 2018
Chapter 530 - Speech and Audiology Services  Effective October 1, 2015
Chapter 531 - Psychiatric Residential Treatment Facility Services  Effective October 6, 2015
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 July 1, 2016
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 (A) - General Administration
Chapter 800 (B) - Quality and Program Integrity
Chapter 900 - Estate Recovery Effective October 2, 2015


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