​PHARMACY UPCOMING CHANGE NOTICE

5/1/2024

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Public Announcement:  WVCHIP Benefits to Align with Medicaid beginning July 1, 2023​​

Upcoming changes to the WVCHIP benefits will go into effect July 1, 2023 to align its services with WV Medicaid.  Members will receive notification explaining more informaiton and who to contact for help or more information.  You can read the notice here, and also the latest CoPayments list here​.

​​Has your address changed due to 911 or moving, or another reason?​

Please click​ ​her for more information on how to update your address to make sure you are receiving all mail from WVCHIP and/or Medicaid. ​​

COVID-19 Vaccination is recommended for anyone 12 years of age and older

5/20/2021

​Recent c​hanges with WVCHIP

5/20/2021Revised

7/31/2020 Original Date

 

Letter to Families

Frequently Asked Questions:  Upcoming Managed Care Changes
 

Routine well-child exams and vaccinations are key to protecting your child's health.  See the following Postcard for additional information:

 Vaccines Postcard approved.pdf.

 

Helpful Information to Families Applying for WVCHIP or Medicaid Coverage during the COVID-19 State of Emergency

 

• The provider community has been directed that COVID-19 testing and treatment for all uninsured individuals will be covered by WV Medicaid or WVCHIP during the national state of emergency.

 

• The weekly $600 Federal Weekly Pandemic Unemployment Compensation payments provided for in the CARES Act will be disregarded as income for Medicaid and WVCHIP eligibility determinations.  Regular weekly unemployment compensation payments will continue to count as income per current policy.

 

• The stimulus payments provided for in the CARES Act, and the other federal bills, will NOT count as income for any Medicaid or WVCHIP category and will be disregarded as an asset for 12 months.
  

​Telehealth Appointments Policy

If you want to have a telehealth appointment, please read the following:  Telehealth Policy​

Updates on Prescription Copays:  Prescription Copayments Reinstated June 15, 2020.  

Coronavirus (COVID-19) Policy – Premium payments and Medical Copayments Waived.  

The West Virginia Children’s Health Insurance Program (WVCHIP) is waiving monthly premiums and copayments for medical services during West Virginia’s declared State of Emergency due to the COVID-19 pandemic.  Copayments on prescription drugs were reinstated June 15, 2020. If you receive an invoice for monthly premiums during the State of Emergency just disregard.  You also should not be asked to make a medical copayment during the State of Emergency.

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COVID-19 Information

The following is a link to a Map of Testing and Screening Sites throughout the State for the Coronavirus COVID-19.  It contains contact information, hours of operations and requirments for testing.  Turn around times vary depending on which laboratory processes the test and results would be released by the original testing facility. 

Here is the link:      Map of Testing Sites and Screening Locations

 

The Department of Health and Human Resources, COVID-19 page remains the best resource for additional information:  Department of Health and Human Resources COVID-19 Information.

 

If you are waiting for test results or have tested positive, there is additional guidance on the following link:  If you are waiting for test results or have tested positive, there is additional guidance on the following link:  https://dhhr.wv.gov/COVID-19/Documents/hcp/What-to-do-if-you-are-waiting-for-test-results-or-have-test.pdf.

 

 

For Substance Abuse Treatment Programs and Behavioral Health Services: 

Get connected with community-based substance treatment programs and behavioral health services near you.

844-HELP-4WV; or go to: www.HELP4WV.com

One Call. One Text. One Click. INSTANT HELP.

 

Frequently Asked Questions

Q. Who can I call or where can I go to ask questions?

A. The toll-free helpline welcomes calls from members and non-members. Please call 1-877-WVA-CHIP (1-877-982-2447). Customer service representatives are available to take your call during the following hours:
Monday - Friday 8AM to 8PM. (TDD and Translation Services Available).

You can also go to the closest primary care center in your area. Staff at these sites can answer questions and help families complete applications. Click here to find a center near you.

You can also get help with benefit questions or other member information by contacting Gainwell Technologies at 1-800-479-3310, or by visiting their website at www.wvmmis.com.

Q. Are there annual enrollment fees or deductibles?

A. No fees or deductibles, but the Premium Plan monthly fees are $35 for 1 member, $71 for 2 or more members.

Q. How long does my child’s coverage last?

A. Your child’s coverage lasts for 12 months, unless your child turns 19 or gets other health coverage (including Medicaid), or your family moves out of state during that time. Children are only eligible for WVCHIP through the end of the month they turn 19. For example, if your child’s birthday falls on August 1, they are covered until August 31. If your child gets other insurance, please call the DHHR change center at 1-877-716-1212 to cancel your WVCHIP coverage.

Q. Are there co-payments required for certain services and prescriptions?

A. Yes. Click here for a list of co-payme​nts.
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Q. What doctors and dentists are in my area?

A. Providers must be enrolled in WVCHIP to receive payment from WVCHIP. To ensure that a doctor or dentist accepts WVCHIP, you will need to contact their office directly. You may go to InsureKidsNow (Click here) to see a list of participating dentists. Check here to find a provider in your area: http://www.wvmmis.com.

Q.When should I take my child to the Emergency Department?

A. Whenever your child is sick or injured, you need to decide how serious the problem is and how soon to get medical care. Click here to read an article on helping you choose whether it is best to call your doctor, go to an urgent care clinic, or go to an emergency department right away.

Q. How can I understand my child’s insurance card?

A. Call Gainwell Technologies at 1-800-479-3310 for an explanation on any part of your child’s insurance card.

Q. I lost my child’s insurance card, what do I do?

A. Call the WVCHIP Helpline at 1-877-982-2447.

Q. Do I need to renew my child’s coverage?

A. Yes. the Bureau for Children & Families or the Department of Health and Human Resources will send a renewal application prior to the end of the eligibility period. Please be sure to keep your address updated with the WVDHHR so you will receive your notices. Do not forget to renew timely so that there is no break in your child's coverage. You may update your address with the DHHR by calling 1-877-716-1212.

Q. My income has changed. What do I do?

A. You do not need to report income changes since your child's insurance is good for 12 months. During the 10th month of coverage, you should receive a renewal form and you can notify CHIP of any income changes at that time.

Q. I have other insurance for my child through my job now. What do I do?

A. Children covered by other insurance cannot also be covered by WVCHIP. Please call the DHHR change center at 1-877-716-1212 to report the new coverage. We can cancel your WVCHIP coverage the day before your new coverage starts so that your child does not go without coverage at any time.

Q. I just had a baby and I want to add him/her onto WVCHIP. How do I do this?

A. Please call the DHHR change center at 1-877-716-1212 to report the change in your family's number of household members.

Q. I moved. What do I need to do?

A. Please call the DHHR change center at 1-877-716-1212 to give us your new address and other contact information. You can also submit the changes online if you wish to do so by clicking here which will take you to the webpage where you can submit the changes.

Q. I am getting a bill because a claim is not being paid. Do I have to pay this?

A. Please call WVCHIP’s third party administrator, Gainwell Technologies at 1-800-479-3310 to speak with someone about your claim.

Q. My child is going to college in the fall. Is he or she still covered?

A. Your child will only be covered by WVCHIP until he/she turns 19 (Coverage actually ends on the last day of the month in which your child turns 19).

Q. Are there benefit limits for some special services?

A. Yes, coverage for services beyond limits listed below is not provided without prior authorization from KEPRO for medical necessity. For Physical Therapy, Occupational Therapy, Speech Thereapy, and Vision Therapy the request for review must come from the Ordering Physician.

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 or prescription 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.

If you get your child’s prescription filled at a pharmacy that participates with Express Scripts, your claim will be filed electronically for you by the Pharmacist. Most national drug stores and supermarket chains participate in the network. To find out if the pharmacy you use is a member of the network, you may call member services at 1-8555-230-7778. If you are using a non-network pharmacy, you will have to pay for the full-cost of the prescription at the time it is purchased. To be fully reimbursed, you must submit a prescription claim form​ along with a receipt or itemized bill.

Please mail the completed form to:
Express Scripts
ATTN:  Commercial Claims
PO Box 14711
Lexington, KY 40512-4711.

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 the Express Scripts number at 1-855-230-7778.

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 DHHR change center at 1-877-716-1212. The child will lose coverage in this state and must reapply in th​eir 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.


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