West Virginia Family Health (WVFH) will no longer be participating in the Medicaid program with the Bureau for Medical Services (BMS) effective July 1, 2019. As such, current WVFH members will be transitioned to another managed care organization between May 1 and July 1.
WVFH members will be receiving a letter informing them that they must choose another managed care organization. These former WVFH members will have a 90-day transition period whereby The Health Plan (THP) will honor the prior authorizations for services already granted to WVFH. BMS will share those prior authorizations with THP and the list will be used during the transition phase for medical and claims processing.
The Health Plan’s prior authorization lists for medical and behavioral health services are located on the provider portal at myplan.healthplan.org. New services and procedures requiring authorization by THP must be requested prior to performing the service or procedure. To avoid claim denials, please remember to verify eligibility at each visit.
Questions may be directed to the provider engagement representative for your county.
Click here to view the territory map or contact customer service at 1.811.613.8385.