Credentialing in West Virginia

West Virginia Medicaid is run by the Bureau for Medical Services (BMS) with Gainwell Technologies as fiscal agent handling provider enrollment. It is one door for everything: providers joining WV Medicaid, WVCHIP, or any WV Medicaid MCO contact the Provider Services Enrollment Unit at 888-483-0793. Keep your license copy current with Gainwell. Participation can be terminated over a stale license.

WV BMS Gainwell Technology page via kb/states/wv.md · checked Jul 2026

W.Va. HB 4335 (2026, Ch. 182) sets the strongest Medicaid-side credentialing clocks we track in any state: by July 1, 2026, the Department of Human Services must complete Medicaid enrollment determinations within FIVE business days of a completed application (incomplete applications flagged electronically within two business days), and Medicaid MCOs must complete provider credentialing within 60 calendar days of a clean application. It also repeals the old uniform-credentialing article § 16-1A. Citation trap: do not cite live W.Va. Code § 9-5-34, a pharmacy statute from HB 5430 won the codification race for that number; the authority is the enrolled bill.

W.Va. HB 4335 enrolled bill via kb/states/wv.md · checked Jul 2026

Mountain Health Trust covers roughly 87% of WV Medicaid members through four MCOs, Aetna Better Health of West Virginia, The Health Plan of West Virginia, Highmark Health Options, and Wellpoint of West Virginia, with behavioral health carved IN (only point-of-sale pharmacy, long-term care, HCBS waivers and NEMT are carved out). Separately, children in foster, kinship or adoptive care and CSEDW members are served by Mountain Health Promise, where Aetna Better Health is the single MCO, bill Aetna MHP for those members, not the family's MHT plan.

WV BMS Mountain Health Trust page via kb/states/wv.md · checked Jul 2026

Providers must revalidate with West Virginia Medicaid/WVCHIP at least every five years (the federal floor), with off-cycle revalidations at BMS discretion, per Provider Manual Chapter 300 (effective 11/17/2025).

WV BMS Provider Manual Chapter 300 via kb/states/wv.md · checked Jul 2026

W.Va. Code § 33-45-2(a)(11) gives commercial insurers four months from a completed application to accept or reject a provider (extendable three months for PSV delays). And, unusually, mandates that a provider who renders services during the credentialing period SHALL BE PAID for them, with the insurer able to recoup only if credentialing is ultimately denied. Bill services rendered while pending, and reserve for clawback until approval lands.

W.Va. Code § 33-45-2 via kb/states/wv.md · checked Jul 2026

On WV Medicaid's Chapter 521 outpatient lane, supervised social-work tiers (LGSW, LCSW) and supervised psychologists ARE billable renderers (psychologist supervisors bill, capped at four supervisees; LICSW/LPC/LCSW/LGSW under a physician practice bill with the AJ modifier), but provisionally licensed counselors (PLCs) are shut out of both doors: no enrollment and no billing under a supervisor. The Chapter 503 clinic lane softens this: Licensed Behavioral Health Centers may have master's-level therapists, including provisional counselors, render H0004-class counseling under the agency's clinical supervision policy, with the agency billing.

WV BMS Provider Manual Chapter 521 via kb/states/wv.md · checked Jul 2026

West Virginia has passed the Counseling Compact but is not yet issuing or receiving privileges. As of July 2026 the issuing states are only AZ, GA, IN, LA, MN and OH. Counselors and MFTs license through the WV Board of Examiners in Counseling; the supervised counselor tier is the Provisionally Licensed Counselor (PLC).

counselingcompact.gov via kb/states/wv.md · checked Jul 2026

West Virginia's Interstate Telehealth Registration (W.Va. Code § 30-1-26) spans all Chapter 30 licensing boards. The Board of Medicine issues it to MD/DPM/PA at $175 (annual, expires March 31 regardless of issue date), requiring an active unrestricted license elsewhere. No Schedule II prescribing via telehealth (established-patient exception), which makes it unusable for stimulant-prescribing psych-NP models; the 12-month in-person rule exempts behavioral health, addiction and palliative care.

WV Board of Medicine ITR via kb/states/wv.md · checked Jul 2026