As of July 1, 2017, pharmacy services for WV Medicaid Managed Care Organization (MCO) members will be administered by the Traditional Fee for Service Pharmacy Program, according to a notice released by West Virginia Medicaid. All prescriptions should be billed as follows: BIN 610164 and PCN DRWVPROD
Questions regarding claims processing should be directed to the Molina POS Pharmacy Help Desk at 888-483-0801. For further information regarding claims processing, the Vendor Specification document can be found on the Molina website: https://www.wvmmis.com
The Molina claims processing system will accept only the member’s WV Medicaid Identification Number (MAID) that is printed on the member’s MCO card or on the member’s traditional, blue Medicaid card/ The MAID is 11 digits and generally begins with a zero (0).
In the event the member does not have their card, the following information may be helpful:
Aetna ID Card = Medicaid ID
WV Family Health ID Card = Both WVFH and Medicaid ID numbers printed on card
Unicare ID Card = WV Medicaid ID Number minus the letter W at the front of the ID
The Health Plan ID Card = Both THP and Medicaid ID numbers printed on card
Call Molina’s Automated Voice Response System (AVRS) at 1-888-483-0801 for confirming member Medicaid Identification Numbers and eligibility verfication.
Letters will be sent to each member or their family to inform them of the change in pharmacy benefit administration.
Requests for prior authorization or claim edit overrides should be directed to the Rational Drug Therapy Program by fax 800-531-7787 or telephone 800-847-3859.
Nursing Home Providers: Please be aware your batch billing must be adjudicated before 12:01 a.m. on July 1, 2017. Any claims submitted with a Date of Service before July 1,2017, will be denied by the Fee for Service Pharmacy Program (Molina) and will not be accepted by the MCO Pharmacy Benefits Managers after 12:01 a.m.
