Effective October 17, 2018, West Virginia Medicaid will begin to deny all claims for prescriptions written by any prescriber not enrolled with West Virginia Medicaid. This includes hospital residents and interns, advanced practice nurse practitioners, physician assistants and pharmacists who administer vaccines.
Even though a facility employing a prescriber (clinic, hospital or pharmacy) is currently enrolled, the individual prescriber must also be enrolled.
Failure to enroll with West Virginia Medicaid as a prescribing provider can cause consequences for patients.
The requirements for prescribers to enroll is a provision of the Patient Protection and Affordable Act of 2010. All prescribers serving Medicaid patients MUST enroll and their name and national provider identifier (NPI) must be recorded on claims for prescription medications submitted for Medicaid members on and after October 17 2018.
Providers may enroll as a billing provider or an “ordering, referring or prescribing” (ORP) provider.” “ORP only provider” is a category for prescribers who write orders, refer or prescribe medications, but do not actually submit claims to Medicaid for their services. “ORP only providers” may not bill Medicaid for services.
Prescribers not enrolled may go to the website for West Virginia Medicaid claims processor, Molina Medicaid Solutions, at http://wvmmis.com and enroll online as a billing provider or as an “ORP only provider.” Provider application approval is 5 days from receipt of a completed application. A paper application can be requested by calling Molina Provider Enrollment at 888-483-0793.
To prevent interruptions in Medicaid members’ access to needed prescription medications, prescribers must make sure they are enrolled with West Virginia Medicaid. For questions, please contact Molina Provider Enrollment at 888-483-0793 or the Molina Pharmacy Help Desk 888-483-0801.