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.

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.

 Visit the Join Our Network page for updated process changes effective June 13, 2016

WVFH Medicaid plan claims should be billed with the NPI number you enrolled with Highmark Blue Cross Blue Shield West Virginia (Highmark West Virginia).

Effective Feb. 1, 2016, the West Virginia Family Health (WVFH) Medicaid plan will no longer accept hand-written paper claims.

While electronic claims submissions (via clearinghouses or vendors) are always preferred, paper claims will still be accepted as long as they contain typed information in all required fields. Hand-written paper claims will be returned to the submitting provider.