Bulletins & Policies

WVFH bulletins and policies are designed to provide direction and information to you.

Bulletins

Introduction Letter to the Operational Changes Effective Sept 1

Pharmacy Benefit Carve-Out - Effective July 1, 2017

LARC Payment Policy (pdf)

New Phone Number for Providers (pdf)

Enhanced Clinical Editing Processes (pdf)

Observation and Extended Assessment (pdf)

Emergency Department Usage (pdf)

High Cost Drug Invoice Pricing (pdf)

 

General Policies

Pharmacy Benefit Carve-Out - Effective July 1, 2017

LARC Payment Policy (pdf)

Observation and Extended Assessment and Management in Facilities for Physical Health Conditions Policy (pdf)

Facility Emergency Department Policy (pdf)

Place of Service Policy (pdf)

Reporting Requirements STD TB Diseases (pdf)
 

Post Service Claim Edit Policies

Brineura

Exondys 51 (Eteplirsen) 

Interleukin-5 Inhibitors

Ocrevus

Portrazza Necitumumab

Velcade

 

Prior Authorization

Adcetris

Alimta

Avastin

Botox

Erbitux

Faslodex

G-CSF

Herceptin

Intravenous Immunoglobulin (IVIG) 

IV/Injectable Oncology Agents

Keytruda

Kyprolis

Opdivo 

Perjeta

Remicade 

Rituxan

Soliris

Tysabri

Vimizim

Xolair

Yervoy

Medical Policies

Ambulatory Blood Pressure Monitors

Bariatric Surgery Policy (pdf)

Breast Reconstruction

Bronchial Thermoplasty

BCR-AB1(pdf)

BRCA1 and BRCA2 Genetic Mutation Testing and Related Genetic Counseling (pdf)

BRAF Mutation Analysis 

Capsule Endoscopy

Cardiac Rehabilitation, Phase II Outpatient

Carpal Tunnel

Chromosomal Microarray Analysis: Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP) (pdf)

Cochlear Implants

Colorectal Cancer Screening

Continuous Glucose Monitoring 

Custom Made Oral Appliances

EGD

Electrical Bone Growth Stimulators for spinal indications

Enteral Feeding In-line Cartridge

Fecal Transplant

Fetal Aneuploidy Testing Using Noninvasive Cell-Free Fetal DNA (pdf)

Genetic Testing for Colorectal Cancer Susceptibility (pdf)

Genetic Testing for Cystic Fibrosis Policy (pdf)

Genetic Testing for Warfarin Therapy

Genetic Testing Panels

Home Oxygen Therapy  

Hyperbariac Oxygen Therapy Policy (pdf)

Implantable Cardioverter Defibrillator (ICD)

Macular Degeneration

Molecular Markers for Fine Needle Aspirates of Thyroid Nodules 

Molecular Markers for Lung Cancer

Negative Pressure Wound Therapy in the Outpatient Setting (pdf)

Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C (pdf)

Noninvasive Positive Pressure Ventilation Policy (pdf)

Oncotype DX Assay Policy (pdf)

Panniculectomy

Passive Oscillatory Devices in the Outpatient Setting (pdf)

BCR-AB1(pdf)

Pulmonary Rehabilitation

Skin Replacement

Testing for Genetic Disease (pdf)

Wearable Cardioverter Defibrillators Policy (pdf)

Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders (pdf)

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