Get West Virginia Prior Authorization

Drugs That May Require Prior Authorization Drug ClassDrugs in ClassAndrogens-Anabolic SteroidsAndrol-50, , Nandrolone, OxandrinAnticoagulantsEliquis, , XareltoAntipsoriatic AgentsOtezla, , Taltz, TremfyaApokyn, KynmobiApokyn, Kynmobi243 more rows

Prior authorization is required for certain Medicaid services and supplies, like home-based care or durable medical equipment (DME).

Drugs That May Require Prior Authorization Drug ClassDrugs in ClassAndrogens-Anabolic SteroidsAndrol-50, , Nandrolone, OxandrinAnticoagulantsEliquis, , XareltoAntipsoriatic AgentsOtezla, , Taltz, TremfyaApokyn, KynmobiApokyn, Kynmobi243 more rows

Drugs That May Require Prior Authorization Drug ClassDrugs in ClassAndrogens-Anabolic SteroidsAndrol-50, , Nandrolone, OxandrinAnticoagulantsEliquis, , XareltoAntipsoriatic AgentsOtezla, , Taltz, TremfyaApokyn, KynmobiApokyn, Kynmobi243 more rows

Prior authorization is required for certain Medicaid services and supplies, like home-based care or durable medical equipment (DME).

If you have any questions, please contact the Provider Enrollment Unit at (888) 483-0793, option 3, Monday through Friday, between the hours of 7:00 am and 7:00 pm (EST). Begin the provider enrollment process, choose one of the following: For new enrollments, please contact Gainwell Technologies Provider Enrollment.

Drugs That May Require Prior Authorization Drug ClassDrugs in ClassAndrogens-Anabolic SteroidsAndrol-50, , Nandrolone, OxandrinAnticoagulantsEliquis, , XareltoAntipsoriatic AgentsOtezla, , Taltz, TremfyaApokyn, KynmobiApokyn, Kynmobi243 more rows

You may call Provider Services at (888)-483-0793 or (304) 348-3360 to check if a claim has been received. Please have your ten-digit WV Medicaid provider number, the patient's eleven digit Medicaid number, the date/s of service and the billed amount when calling Provider Services to check claim status.

If you have any questions, please contact the Provider Enrollment Unit at (888) 483-0793, option 3, Monday through Friday, between the hours of 7:00 am and 7:00 pm (EST). Begin the provider enrollment process, choose one of the following: For new enrollments, please contact Gainwell Technologies Provider Enrollment.

Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

You may call Provider Services at (888)-483-0793 or (304) 348-3360 to check if a claim has been received. Please have your ten-digit WV Medicaid provider number, the patient's eleven digit Medicaid number, the date/s of service and the billed amount when calling Provider Services to check claim status.

Examples of services that commonly require prior authorization before being approved include: Diagnostic imaging (such as MRIs, CTs, and PET scans) Durable medical equipment (such as wheelchairs) Rehabilitation (like physical or occupational therapy)

Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

What is prior authorization? This means we need to review some medications before your plan will cover them. We want to know if the medication is medically necessary and appropriate for your situation. If you don't get prior authorization, a medication may cost you more, or we may not cover it.

Examples of services that commonly require prior authorization before being approved include: Diagnostic imaging (such as MRIs, CTs, and PET scans) Durable medical equipment (such as wheelchairs) Rehabilitation (like physical or occupational therapy)

Prior authorization is required for certain Medicaid services and supplies, like home-based care or durable medical equipment (DME).

What is prior authorization? This means we need to review some medications before your plan will cover them. We want to know if the medication is medically necessary and appropriate for your situation. If you don't get prior authorization, a medication may cost you more, or we may not cover it.

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The West Virginia Department of Health and Human Resources, Bureau for Medical Services (BMS), is the designated single state agency responsible for the administration of the State's Medicaid program.

Prior authorization is used to help plan providers ensure that their members are not being prescribed the most costly medication, until less expensive alternatives have been pursued. This "cost check" helps keep overall plan costs down and allows employers to continue offering drug benefits.

Prior authorization is required for certain Medicaid services and supplies, like home-based care or durable medical equipment (DME).

For these agents, West Virginia Medicaid contracts with KEPRO prior authorization services. Prior authorizations must be requested through KEPRO, by calling (304) 343-9663, faxing (866) 209-9632 or emailing WVMedicaidServices@KEPRO.com.

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The West Virginia Department of Health and Human Resources, Bureau for Medical Services (BMS), is the designated single state agency responsible for the administration of the State's Medicaid program.

Prior authorization is used to help plan providers ensure that their members are not being prescribed the most costly medication, until less expensive alternatives have been pursued. This "cost check" helps keep overall plan costs down and allows employers to continue offering drug benefits.

For these agents, West Virginia Medicaid contracts with KEPRO prior authorization services. Prior authorizations must be requested through KEPRO, by calling (304) 343-9663, faxing (866) 209-9632 or emailing WVMedicaidServices@KEPRO.com.