Provider Information

Molina Medicaid Solutions

​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

​Form ​Address ​City ​State ​ZIP
​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

​Form ​Address City​ State ZIP
Hysterectomy, Sterilization & Pregnancy Termination ​PO Box 2254 ​Charleston ​WV ​25328-2254

    

Bureau for Medical Services

Long Term Care ​(304) 356-4886
Third Party Liability​ ​(304) 558-1700
 
Medicare Buy-In  ​ ​(304) 356-4910
​PAAS       ​(800) 982-7227
​PAAS Options ​(800) 449-8466
​Case Planning Unit    ​(304) 558-1776 Fax

               

KEPRO-Utilization Management Contractor (UMC)
Long Term Care​
Aged and Disabled Waiver (ADW)
​Phone Number ​844-723-7811
FAX Number ​866-212-5053
​General Email WVADWaiver@kepro.com
​Additional Information for PAS ADWDocumentation@kepro.com
​Submit Re-eval 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@kepro.com
​Submit additional information for prior authorization (PA) 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@kepro.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@kepro.com
​Submit requests https://c3kepro.com/cms/main
​Medical Services
​Phone Number
​800-346-8272
​FAX Number ​866-209-9632
​Email wvmedcalservices@kepro.com
ORG Managers: C3 Care Connection Enrollment
​AUM Managers: C3 Care Connection Provider Portal
​General Medical Information wvmedicalservices@kepro.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

 
Disproportionate Share Hospital Survey
SFY 2014 DSH Survey Form  Click Here

350 Capitol Street | Room 251 | Charleston, WV 25301 | Phone: (304) 558-1700 | Contact Us | Site Map