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Prescribers for Medicaid Members Must Register with West Virginia Medicaid - Current Topics

Prescribers for Medicaid Members Must Register with West Virginia Medicaid

On and after October 17, 2018, West Virginia Medicaid will begin to deny all claims for prescriptions written by any prescriber not enrolled with West Virginia Medicaid. This includes hospital residents and interns, advanced  practice nurse practitioners, physician assistants and pharmacists who administer vaccines.   Even though the facility you are employed by (clinic, hospital or pharmacy) is currently enrolled, individual prescribers must also be enrolled.   Failing to enroll with West Virginia Medicaid as a prescribing provider could cause serious consequences for your patients.

The requirement for prescribers to enroll is a provision of the Patient Protection and Affordable Care Act of 2010. All prescribers serving Medicaid patients MUST enroll and their name and national provider identifier (NPI) must be recorded on claims for prescription medications submitted for Medicaid members on and after October 17, 2018.  Providers may enroll as a billing provider or an “ordering, referring, or prescribing” (ORP) provider.” “ORP only provider” is a category for prescribers who write orders, refer, or prescribe medications, but do not actually submit claims to Medicaid for their services. “ORP only providers” may not bill Medicaid for services.

If you are not already enrolled, you may go to the website of the West Virginia Medicaid claims processor, Molina Medicaid Solutions, at https://www.wvmmis.com and enroll online as a billing provider or as an “ORP only provider.” The quickest enrollment option is the ORP-only online application process, if applicable.  Provider application approval is 5 days from receipt of a completed application. All required documentation can be uploaded to the portal.

A paper application can be requested by calling Molina Provider Enrollment at 888-483-0793.

To prevent interruptions in Medicaid members’ access to needed prescription medications, prescribers must make sure they are enrolled with West Virginia Medicaid.

For questions, please contact Molina Provider Enrollment at 888-483-0793 or the Molina Pharmacy Help Desk at 888-483-0801.