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.

 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.  

The 2016 WVFH Medicaid Incentive Program is structured to assess and improve the process of care for providers serving WVFH Medicaid Members using select West Virginia Bureau for Medical Services quality measures as the basis of clinical quality performance measurement.

West Virginia Family Health (WVFH) is pleased to announce that it has eliminated the PCP to Specialist referral requirement as of Sept. 1, 2015. We made this change to remove the administrative burden of obtaining referrals, so now you do not have to call to request a referral or download referral forms.
 
Note: WVFH will continue to require a referral for these services:

Beginning Friday, June 19, 2015, you will have the ability to submit radiology authorization requests to National Imaging Associates (NIA) electronically via NaviNet(r) for West Virginia Family Health (WVFH) Medicaid patients.

The WVFH Provider Manual has been updated regarding WVFH Medicaid Responsibilities and Reporting Requirements of Certain Diseases
To allow for surveillance and appropriate investigation/public follow-up, health care providers are required to report certain diseases by state law. West Virginia Family Health (WVFH) may be responsible for:

  1. Further screening, diagnosis and treatment of identified cases enrolled with WVFH to protect the public's health, or
  2. Screening, diagnosis and treatment of case contacts enrolled in WVFH.