West Virginia Medicaid — West Virginia Medicaid (Mountain Health Trust)
| Program name | West Virginia Medicaid (Mountain Health Trust) |
|---|---|
| Provider portal | https://dhhr.wv.gov/bms |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the West Virginia Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in West Virginia
The Blue Cross Blue Shield Association licensee in West Virginia is Highmark Blue Cross Blue Shield West Virginia. See the Highmark BCBS payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in West Virginia
The dominant commercial insurers operating in West Virginia, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in West Virginia
West Virginia Medicaid (Mountain Health Trust) contracts with the following managed-care organizations to administer Medicaid benefits in West Virginia. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in West Virginia
Palmetto GBA is the Medicare A/B MAC for West Virginia: Part A and Part B fee-for-service claims from West Virginia go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to CGS Administrators, LLC as the DME MAC. Home health and hospice claims are processed by CGS Administrators, LLC. In the current Medicare Coverage Database export, 236 active LCDs from these contractors apply to West Virginia claims.
- Palmetto GBA
A/B MAC (Part A and Part B claims)
- CGS Administrators, LLC
DME MAC (durable medical equipment and supplies); Home health and hospice MAC
Selected active Palmetto GBA policies for West Virginia
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L35025 MolDX: Molecular Diagnostic Tests (MDT)
- L37379 Echocardiography
- L39671 Trigger Point Injections (TPI)
- L34415 CT of the Abdomen and Pelvis
- L39853 Outpatient Psychotherapy
- L35724 Urine Drug Testing
- L38779 MolDX: Minimal Residual Disease Testing for Cancer
- L39237 Erythropoiesis Stimulating Agents
- L33445 Removal of Benign and Malignant Skin Lesions
- L33459 Computerized Axial Tomography (CT), Thorax
- L38765 Facet Joint Interventions for Pain Management
- L37794 MolDX: Breast Cancer Index® (BCI) Gene Expression Test
Equipment, home health and hospice policies that apply in West Virginia
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33942 Physical Therapy - Home Health
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting West Virginia billing
- WV SB 619 (2020 — Balance Billing Protection Act, W. Va. Code §33-45)
- W. Va. Code §33-45-3 (prompt pay — 30/40 days electronic/paper clean claim)
- W. Va. Code §16-29F (hospital financial assistance / charity care)
Provider licensing & enrollment in West Virginia
Providers enroll via WVMMIS Provider Portal (Gainwell). Mountain Health Trust MCOs credential via CAQH ProView.
Major health systems headquartered in West Virginia
| Health system | Headquarters |
|---|---|
| WVU Medicine (West Virginia University Health System) | Morgantown, WV |
| Mon Health System | Morgantown, WV |
| Charleston Area Medical Center (CAMC) | Charleston, WV |
| Mountain Health Network (Cabell Huntington + St. Mary's) | Huntington, WV |
| WVU Medicine St. Joseph's | Buckhannon, WV |
Frequently asked questions — West Virginia billing
What is the West Virginia Medicaid program called?
West Virginia's Medicaid program is known as West Virginia Medicaid (Mountain Health Trust). Providers enroll and manage claims through the provider portal at https://dhhr.wv.gov/bms.
What is the West Virginia Medicaid timely filing limit?
West Virginia Medicaid (Mountain Health Trust) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; West Virginia's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does West Virginia Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for West Virginia Medicaid (Mountain Health Trust). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in West Virginia?
The dominant commercial payers in West Virginia include Highmark BCBS, UnitedHealthcare, Aetna, Cigna, Humana, along with the BCBS licensee Highmark Blue Cross Blue Shield West Virginia. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in West Virginia?
West Virginia Medicaid (Mountain Health Trust) contracts with 4 Medicaid MCOs tracked in the QuickIntell registry, including UnitedHealthcare, Aetna Better Health, Highmark BCBS, Molina Healthcare. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in West Virginia?
West Virginia has 3 tracked state-level statutes that affect medical billing and RCM: WV SB 619 (2020 — Balance Billing Protection Act, W. Va. Code §33-45); W. Va. Code §33-45-3 (prompt pay — 30/40 days electronic/paper clean claim); W. Va. Code §16-29F (hospital financial assistance / charity care). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in West Virginia with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to West Virginia Medicaid (Mountain Health Trust) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from West Virginia Medicaid and the member ID card before submission.