Gainwell Technologies
| Member Services |
(888) 483-0797 or
(304) 348-3365 |
Monday - Friday
8:00 AM - 5:00 PM |
| Provider Services |
(888) 483-0793 or
(304) 348-3360 |
Monday - Friday
8:00 AM - 5:00 PM |
| Pharmacy Help Desk |
(888) 483-0801 or
(304) 348-3370 |
Monday - Friday
8:00 AM - 5:00 PM
Sunday
12:00 PM - 6:00 PM |
Access AVRS using same phone numbers 24/7 or visit the website site at www.wvmmis.com
Paper Claim Form Mailing Addresses
| CMS 1500 |
PO Box 3767 |
Charleston |
WV |
25337-3767 |
| UB 04 |
PO Box 3766 |
Charleston |
WV |
25337-3766 |
| ADA 2006 |
PO Box 3768 |
Charleston |
WV |
25337-3768 |
| NCPDB UCF |
PO Box 3765 |
Charleston |
WV |
25337-3765 |
| Reversal/Replacement |
PO Box 3767 |
Charleston |
WV |
25337-3767 |
| Timely Filing |
PO Box 2002 |
Charleston |
WV |
25337-2002 |
Situational Documentation
| Hysterectomy, Sterilization & Pregnancy Termination |
PO Box 2254 |
Charleston |
WV |
25328-2254 |
Bureau for Medical Services
Long-Term Care
|
(304) 352-4241 |
Third-Party Liability
|
(304) 558-1700
|
| Medicare Buy-In |
(304) 352-4262
|
Utilization Management Contractor (UMC)
| Aged and Disabled Waiver (ADW) |
|
| Phone Number |
844-723-7811 |
| FAX Number |
866-212-5053 |
| General Email |
WVADWaiver@acentra.com
|
Additional Information for PAS
|
ADWDocumentation@acentra.com
|
| Submit Re-evaluation MNER requests |
https://wvltc.kepro.com |
|
|
| Intellectual/Developmental Disabilities Waiver (I/DDW) |
|
| Phone Number |
866-385-8920 or 304-380-0617 |
| FAX Number |
866-521-6882 |
| General Email |
WVIDDWaiver@acentra.com
|
| Submit additional information for prior authorization requests |
|
| Submit requests for prior authorization |
https://wvltc.kepro.com |
| |
|
| Personal Care |
|
| Phone Number |
844-723-7811 |
| FAX Number |
866-212-5053 |
| General Email |
WVPersonalCare@acentra.com
|
| Submit requests for prior authorization |
https://wvltc.kepro.com |
| |
|
| Nursing Facility |
|
| Phone Number |
844-723-7811 |
| FAX Number |
844-633-8425 |
| General Email |
WVPAS@acentra.com
|
Submit requests
| https://portal.kepro.com
|
| Medical Services |
|
| Phone Number |
800-346-8272 |
| FAX Number |
866-209-9632 |
Email
|
wvmedcalservices@acentra.com
|
Atrezzo Provider Portal
| https://portal.kepro.com
|
Acentra Health Provider Website
| https://wvaso.acentra.com
|
General Medical Information
|
wvmedicalservices@acentra.com
|
| Medical Form FAX Numbers |
|
| Bariatric, Inpatient, Inpatient Rehab Under 21, Organ Transplants |
844-633-8426 |
Outpatient Surgery
|
844-633-8427 |
| Imaging/Radiology, Laboratory |
844-633-8428 |
| Cardiac & Pulmonary Rehab, Durable Medical Equipment, Orthotics and Prosthetics |
844-633-8429 |
| Home Health, Hospice, Private Duty Nursing |
844-633-8430 |
| Audiology/Speech, Chiropractic, Dental/Orthodontics, Podiatry, Vision, PT/OT |
844-633-8431 |
Carrier List
Carrier Listing by Name Click Here