The West Virginia Bureau for Medical Services would like to make this section of our website another helpful device for providers. BMS will list Frequently Asked Questions in an effort to provide yet another educational resource for providers. Providers should make it a practice to consult the WV Medicaid Provider Manuals for policy and procedure information.
Molina Medicaid Solutions is available to assist the provider community with billing questions, member eligibility, claim status and other inquiries regarding West Virginia Medicaid. The Molina Automated Voice Response System and Molina Web Portal are valuable tools for checking claim status, payment information, and eligibility verification. Molina Healthcare can be reached at (888) 483-0793 or (304) 348-3360 or visit their website at www.wvmmis.com.
How can I obtain eligibility information for a Medicaid beneficiary?
At the time of service, ask the patient for all insurance information which includes primary insurance, Medicare and Medicaid. If the Medicaid card is not available, you may call the Automated Voice Response System (AVRS) or Provider Services at 1-888-483-0793 or (304) 348-3360. Always have your ten-digit WV Medicaid Provider Number when accessing AVRS or calling Provider Services. You may also check member eligibility through the web portal www.wvmmis.com. You will need a web portal account and a Trading Partner Agreement in order to use the web portal.
Can I bill the patient for services WV Medicaid denies?
Medicaid eligible individuals can be billed by the provider for services West Virginia Medicaid denies under the following circumstances: 1) client was not Medicaid eligible at the time of services, 2) service rendered to the client is not a Medicaid covered service, 3) service rendered to the client exceeds Medicaid Program coverage or service limitations. The provider must inform the patient before the service is provided that he/she will be charged. Providers who will not accept the WV medical card must tell the patient before the service is provided that they will not bill Medicaid. For your own benefit, we suggest you have the patient sign a statement acknowledging they will be responsible for the bill and want to continue treatment. (See Common Chapters 300, 400 and 700 under Manuals & Instructions).
Can you tell me why my claim denied?
Claims can deny for numerous reasons. Some denials are caused by billing errors, i.e., invalid or incomplete information on claim. Other denials could be for Medicaid non-covered services. The remittance advice should contain the specific reason why the claim denied. Please check the denial description and correct the claim before resubmission. If you do not understand the denial reason or think the claim denied erroneously, please contact Provider Services at (304) 348-3360 or 1-888-483-0793.
How do I begin billing electronically?
Electronic submission of claims can be through direct data entry on the Web Portal, X12 upload on the Web Portal or through an approved clearinghouse or software vendor. To submit through the Web Portal, you must complete a Trading Partner Agreement. For more information regarding the Web Portal and Trading Partner Registration, please visit website www.wvmmis.com.
Can secondary claims be billed electronically?
Secondary claims can be submitted electronically through the Web Portal or billed using an approved clearinghouse or software vendor. [Please Note: Denied Medicare claims can be submitted electronically with Medicare paid date and Medicare adjustment reason code. Denied Insurance Primary claims cannot be submitted electronically. These claims must be submitted on paper with EOB attached.]
If I bill electronically, will I get paid faster?
The best way to get regular payment is to bill frequently throughout the week. Medicaid pays “clean” claims on a “first in first out” basis. Medicaid payment is based on availability of funds. The advantage of billing electronically is that your claims arrive in the system faster than paper. If there are errors on the claim, the denial will go out on the next remittance advice which allows for rapid claim correction by the provider.
How do I receive electronic remittance advices?
Remittance Advices are posted on the Web Portal for pay-to-providers who elected to receive Electronic Remittance Advices. If you would like to change the method in which you receive your RA, please contact the EDI helpdesk at 888-483-0793, option 6 or (304) 348-3360. You may also contact via email at firstname.lastname@example.org.
How do I check on the status of a claim?
Always review your Remittance Advice (RA) upon receipt. You may check claim status using the Molina web portal, www.wvmmis.com. A Claims In Process (CIP) report is also available at this site. You will need a web portal account and a Trading Partner Agreement in order to access. You may call Provider Services at (888)-483-0793 or (304) 348-3360 to check if a claim has been received. Please have your ten-digit WV Medicaid provider number, the patient’s eleven digit Medicaid number, the date/s of service and the billed amount when calling Provider Services to check claim status. When sending paper claims, please allow extra time for mail handling before calling to see if your claim has been received and entered into the system.
Why are my claims not crossing over from Medicare?
West Virginia Medicaid currently receives electronic claims data from the Medicare intermediaries. [RHC/FQHC, and Hospitals please note: Only inpatient claims are processed. Outpatient hospital claims must be billed by the provider.] Two components must be in place before claims will cross over directly from Medicare and process. The member’s Medicare ID number must be on file with WV Medicaid accurately and the provider’s Medicare Provider number(s) must be on file with WV Medicaid. If your claims are not crossing over from Medicare, please contact Provider Services at (888) 483-0793 or (304) 348-3360.
When do I need to use the 51 modifier?
Effective with dates of service July 1, 2007, the claims processing system will apply modifier 51 to professional claims based upon the RBRVS rules. For further information on modifier 51 or to see if a certain CPT code is subject to this modifier, please refer to the RBRVS manual which is located on this website under “Manuals & Instructions.”
Do I need a sterilization consent form for a patient who has had a previous hysterectomy?
No. When surgical procedures involving “tubes and /or ovaries” are done on a patient who has had a hysterectomy, an operative report, discharge summary and/or history and physical must be attached to the paper claim along with a cover letter or transmittal letter stating “patient previously sterilized, see attached” and sent to: Molina Sterilization/Hysterectomy Unit, PO Box 2254, Charleston, WV 25328-2254. If you have billed for a sterilization/hysterectomy procedure and it has been over thirty days since you submitted the claim, you may contact Provider Services at (304) 348-3360 or (888-) 483-0793 to inquire about the claim.