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Claims Processing

The Medicaid Management Information System (MMIS) processes over 15 million fee-for-service claims annually.  Claims are processed from over 11,000 providers for health care services rendered on behalf of the State's approximately 300,000 Medicaid members.  The MMIS determines which fee-for-service provider claims are appropriate to pay and the payment amount through a complex series of policy tables and data edits.

The "Claims Doctor"

Are you having difficulty processing a claim?
Does your head hurt every time you receive a remittance?
Do you feel a "pain" in the back of your neck when you file a claim?
If so, please take a moment to review the FAQ and Billing Tips on this website. If your prognosis is still undetermined, e-mail the "Claims Doctor".  The "Claims Doctor" will listen to your symptoms and diagnose your ailments so you can process those claims without all the side effects.

Email the "Doc" at dhhrmedclaimdoc@wv.gov

 

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