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Provider Manual 

Please be advised that the West Virginia Medicaid Provider Manual does not address all the
complexities of Medicaid policy and procedures and must be supplemented with all Federal and State Laws and Regulations.  Billing instructions can be found on the Molina Medicaid Solutions website at: http://www.wvmmis.com/contentDelivery/manuals.screen.

Important Notice:  Effective October 1, 2010, states were required by the Centers for Medicare and Medicaid Services (CMS) to incorporate all National Correct Coding Initiative (NCCI) methodologies into their systems for processing Medicaid claims.  The following chapters of the BMS Provider Manual will be updated on an ongoing basis to reflect this requirement.  Until all chapters are updated, this notice serves to inform providers that the required NCCI methodologies supercede any language in the BMS Provider Manual chapters as it relates to coding and/or the processing of claims submitted for services provided to WV Medicaid members.   

 For information on NCCI as it applies to Medicaid, go to http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/National-Correct-Coding-Initiative.html

TABLE OF CONTENTS

Chapter 100 - General Information
Chapter 200 - Definitions
Chapter 300 - Provider Participation Requirements
Chapter 400 - Member Eligibility
Chapter 501 - Aged & Disabled Waiver
Chapter 502 - Behavioral Health Clinic
Chapter 503 - Behavioral Health Rehabilitation
Chapter 504 - Chiropractic Services
Chapter 505 - Dental Services
Chapter 506 - DME/Medical Supplies
Chapter 507 - ASC & Birthing Centers
Chapter 508 - Home Health
Chapter 509 - Hospice Services
Chapter 510 - Hospital Services
Chapter 511 - ICF/MR Services
Chapter 512 - Traumatic Brain Injury (TBI) Waiver Services
Chapter 513 - Intellectual Developmental Disabilities (I/DD) Waiver Services
Chapter 514 - Nursing  Facility Services
Chapter 515 - Occupational/Physical Therapy
Chapter 516 - Orthotics & Prosthetics
Chapter 517 - Personal Care
Chapter 518 - Pharmacy Services
Chapter 519 - Practitioner Services
Chapter 520 - Podiatry Servies
Chapter 521 - Psychological Services
Chapter 522 - RHC FQHC Services
Chapter 523 - Targeted Case Management
Chapter 524 - Transportation
Chapter 525 - Vision Services
Chapter 526 - Children with Disabilities Community Services Program
Chapter 527 - Mountain Health Choices
Chapter 528 - Radiology Services
Chapter 529 - Laboratory Services
Chapter 530 - Speech and Audiology Services
Chapter 531 - Psychiatric Residential Treatment Facility Services
Chapter 532 - Private Duty Nursing
Chapter 600 - Reimbursement Methodologies
Chapter 800 (A) - General Administration
Chapter 800 (B) - Quality and Program Integrity
Chapter 900 - Estate Recovery

Laboratory PA List
Radiology PA List and Form


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