Provider Resources

Provider Notice:  WVCHIP Benefit Transition

Please see the following information regarding the ongoing transition to align WVCHIP benefits to WV Medicaid, due to the West Virginia Legislature's, House Bill 4649.  Read here to see the complete notice. ​​​

Providers:  Payment Error Rate Measurement (PERM) Review - Reminder to Submit Medical Records

The Centers for Medicare & Medicaid Services (CMS) Payment Error Rate Measurement (PERM) Program for Reporting Year (RY) 2023 is currently reviewing the WV Medicaid and WV Children's Health Insurance program (WVCHIP) to measure imporoper payments in order to maintain the integrity of the Medicaid program.  The Review Contractor (RC) Empower AI is authorized to collect information from providers and to review documentation to ascertain adherence to Medicaid regulations.  Please read here for additional information.

​​Up-to-Date Addresses

Please remind your patients to make sure their addresses are up-to-date.  Some addresses have been changed by 911, some have been changed because of moving, and other reasons.  Click here for more Information.

Telehealth Policy​​

 WVCHIP Telehealth Policy

​New Outpatient Therapy Guidelines

Physical and Occupational Therapy Guidelines
Speech Therapy Guidelines
Vision Therapy Guidelines

Prior Approval/Prior Authorization Forms

Prior Approval for Out of State/Out of Network Services
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​​

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.