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Provider Resources



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 
CVS Caremark 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 (2019)

Benefit Resources & Reimbursement

Reimbursement for Developmental Screenings

Applied Behavioral Analysis

Policy: Applied Behavior Analysis  (Effective January 2019)
2020 Applied Behavior Analysis (ABA) Allowable Services and Coding Guide Effective July 1, 2020

Minimum Training Standards: Front Line ABA Staff

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.