Beginning 07/01/2024, WVCHIP Pharmacy POS claims will be processed by West Virginia Medicaid's claims processor, Gainwell Technologies.  WVCHIP Pharmacy claims with dates of service from now through 06/30/2024 will continue to be processed by ESI, WVCHIP's current Pharmacy Benefit Manager (PBM).  Please use WV Medicaid's Bank Identification Number (BIN), 610164, and Processor Control Number, DRWVPROD for WVCHIP drug claims with dates of service of 07/01/2024 and after.  NOTE:  WVCHIP members will receive new member cards prior to 07/01/2024 with updated information removing ESI as the PBM.  Member ID numbers are not changing. 

For questions regarding processing of WV​CHIP pharmacy claims as of 07/01/2024, please refer to Health PAS Online - WV Medicaid and WVCHIP's Provider and Member portals, located at this link:  https//www.wvmmis.com/default.aspx

Further details, specifically regarding WVCHIP claims processing, including the above named BIN and PCN, is located in the current WV Medicaid Vendor Specification Document D.O. on the Pharmcy link on that page, under the "Reference Material": tab, here:  https://wvmmis.com/Pharmacy/Forms/Allitems.aspx​

WVU's Rational Drug Therapy Program (RDTP) will continue to manage Prior Authorizations (PA) and Edit Overrides (EO) for WVCHIP.  RDTP's phone number is 1-800-847-3859, and the fax number is1-800-531-7787.  If you have any general question regarding this update, please contact Gainwell Technologies' WV Medicaid and WVCHIP's Pharmacy Provider Help Desk at 1-888-483-0801.  The help desk number for members is 1-888-483-0797.​

Providers must be enrolled with WV Medicaid and CHIP to ensure that prescriptions are processed and paid.  Failing to enroll as a prescribing provider could cause your patients' prescriptions to be denied at the pharmacy.  ​If you are not already enrolled, please visit https://www.wvmmis.com and enroll online as a billing provider or as an "ORP Only Provider."  The quickest enrollment option is the ORP-Only online application process.  To prevent interruptions in member's access to needed prescription medications, prescribers must make sure they are enrolled with West Virginia Medicaid.

Prior Approval/Prior Authorization Forms

Precertification for Services

​Prescription Drug Plan​

Current Preferred Drug List​ 
Express Scripts, Inc. (ESI) Prescription Reimbursement Claim Form​​
Prior Approval Request for Prescriptions​
Prior Approval Request Form for ADD Medications
Prior Approval Request Form for Antipsychotics Medications, and Guidelines​

Immunization Resources

​CPT Codes for Immunizations​​​
Immunization Schedule for Ages 0-6 years
Immunization Schedule for Ages 7-18 years

Healthcheck Forms

Healthcheck Provider Manual and Forms

Kindergarten Screening Document

Dental Information

Dental ​Provider Guide​​

Dental Procedure Codes (2021)

Benefit Resources & Reimbursement

Reimbursement for Developmental Screenings

Applied Behavioral Analysis

​Applied Behavioral Analysis Policy Update​​ (Effective February 1, 2023)

Pre-Authorization Requests​

Providers who need to submit Prior Authorization requests for ABA services for a WVCHIP member should go to http://wvaso.kepro.com​ to complete your request electronically.  If you experience any problems with your submission, please contact KEPRO at 1-888-571-0262.

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