Providers

West Virginia Family Health Plan (WVFH) works with a top quality network of physicians and related professionals to assist in providing care to our members in 55 counties in West Virginia.  We are proud of those who work with us to serve our members.

Our partnership with the providers is designed to ensure we look to serve our members in a way that gives the best possible outcome and access to meet member’s healthcare needs.

Please join us at the 2018 Spring Provider Workshops so that you and your staff will be aware of upcoming developments which may impact your practice/organization.

UPDATE: Your practice received the below announcement in November 2017 regarding Prior-Authorization planned for January 8th implementation. However, West Virginia Family Health has decided to push back implementation to March 5th, 2018 to ensure providers have an optimal experience.

As a part of our continuous efforts to improve the quality of care for our members, West Virginia Family Health will implement prior authorization process for the following medications effective with dates of service from March 5th, 2018.

On January 1, 2018, West Virginia Family Health will transition to its new operating system. We've communicated information on this change, which will provide a more efficient and accurate operating environment and other benefits. However, you may experience some temporary minor impacts as a result of this migration. Detailed below is further information on what you can expect during the transition.

On January 1, West Virginia Family Health will transition to its new processing platform (EHS) which will provide you with improved service and responsiveness by integrating to a single point. This upgrade will allow for more timely and accurate payments and combined operations functionality. We want to ensure that our service standards remain consistent throughout the transition and that this integration is as seamless as possible to both Providers and our members that you serve.

As a part of our continuous efforts to improve the quality of care for our members, West Virginia Family Health will implement prior authorization process for the following medications effective with dates of service from January 8th, 2018.

The prior authorization process will apply to all West Virginia Family Health members. Medical necessity criteria for each of the medications listed below are outlined in the specific medication policies available online.

View the Announcement

West Virginia Family Health Plan (WVFH) will transition to the EHS processing platform during 4th quarter 2017. The system transition will provide you with improved service and responsiveness by integrating resources and expertise into a single point.

For more information view the EHS Presentation. 

You recently received a letter from Highmark West Virginia (d.b.a. Highmark Blue Cross and Blue Shield of West Virginia and/or through its subsidiary Highmark West Virginia Family Health Plan, Inc.) requesting a Medicaid disclosure form for your practice.

PLEASE DISREGARD THE HIGHMARK DISCLOSURE REQUEST.

*The below information was distributed by WV Bureau for Medical Services as guidance related to the pharmacy benefit carve out, effective July 1, 2017.*

Pharmacy Benefit Carve Out

Please review three special bulletins related to services provided to WVFH members

Beginning May 1, 2016, you will have the ability to submit claim inquiry requests to a dedicated fax number for West Virginia Family Health (WVFH) Medicaid patients.