STATE OF WEST VIRGINIA
DEPARTMENT OF HEALTH AND HUMAN RESOURCES
BUREAU FOR MEDICAL SERVICES
350 Capitol Street, Room 251
Charleston, West Virginia 25301-3712
Telephone: (304) 558-1700 Fax: (304) 558-1451
Notice to Pharmacy Providers
On October 17, 2018, prescription claims will deny for Medicaid members whose prescribers are not enrolled with Medicaid. West Virginia Medicaid is required to deny these prescriptions in order to comply with Federal regulations.
If a prescription denies for one of your patients due to edit 7091 (Prescriber not enrolled with Medicaid), please ask the member to contact the prescriber’s office and request that an enrolled prescriber in that office provide them with a prescription which can be written, electronically prescribed or transmitted via telephone or fax.
Exception: if a patient is prescribed a drug used to treat a behavioral health condition (depression, schizophrenia, anxiety, ADD, ADHD, etc) and it results in a denial with Edit 7091 (prescriber not enrolled with Medicaid), please use the NPI of the behavioral health facility in which your patient is being treated. You may call the facility, the Molina Pharmacy Help Desk at 888-483-0801 or the Bureau for Medical Services Pharmacy Office at 304-558-1700 to obtain the NPI number. This is a temporary measure while Molina enrollment continues to process enrollment applications through 2018.
For claims prescribed by pharmacists, you may temporarily use the NPI of your pharmacy. But please continue to pursue your individual pharmacist enrollment with Molina.
You will be notified in the future when the enrollment process has been completed and you can begin using the individual prescriber’s NPI.
Thank you for your help in this matter. For more information, you may call the Molina Pharmacy Help Desk at 888-483-0801 or the Bureau for Medical Services at 304-558- 1700.