Telehealth Appointments Policy - If you want to have a telehealth appointment, please read the following: Telehealth Policy.
Substance Use & Behavioral Health Support
Connect with community-based treatment programs and behavioral health services near you.
Call: 844-HELP-4WV; or visit: www.HELP4WV.com
| Medical Necessity Review Required Beyond These Limits | |
| Type of Service | Benefit Limit |
| Mental Health | 26 visits |
| Chiropractic Services | 20 visits |
| Occupational Therapy | 20 visits |
| Physical Therapy | 20 visits |
| Speech Therapy | 20 visits |
| Vision Therapy | 20 visits |
| Primary Care | 26 visits |
| Specialty Care | 26 visits |
Q. What do I need to do if my child needs medical service outside West Virginia?
A. You must call KEPRO at 1-888-571-0262 to get prior approval that the medical claim will be paid. Fax: 1-866-438-1360.
Q. Do I need to file claims for medical services?
A. Usually medical claims for a child covered by WVCHIP will be filed by the healthcare provider. If you need to file a medical claim, use the WVCHIP medical claim form and mail the completed form and a copy of the itemized bill and diagnosis to:
Gainwell Technologies
PO Box 3732
Charleston, WV 25337
Member reimbursements for medical will pay up to WVCHIP's fee schedule and benefit limits will apply. Members are encouraged to seek providers enrolled in WVCHIP for their appointments to avoid additional out of pocket costs.
Q. Who do I contact about pre-certification or pre-authorizations?
A. Call KEPRO Toll-Free at 1-888-571-0262. Fax: 1-866-438-1360. Email: wvchip@kepro.com
Q. Who do I contact about drug interactions or drug comparisons?
A. Call 1-888-483-0797.
Q. What happens to WVCHIP coverage when a child moves out of state?
A. It is the parent’s responsibility to report this information to the DoHS Customer Service at 1-877-716-1212. The child will lose coverage in this state and must reapply in their new state. Claims will not be paid for non-state residents.
For more information about benefits, click here for the Summary Plan Description (SPD) and WVCHIP's Notice of Privacy Practices.
WVCHIP Insurance Card - New Cards for WVCHIP members
- Members will be issued a temporary paper card that will come with their CHIP Approval Notice which will have their CHIP PIN on it which providers may use to bill.
- Members are able to print eligibility at www.wvmmis.com to provide to their physician until they receive their plastic card.
- Providers may also check eligibility through the provider portal at www.wvmmis.com using the member's PIN.
