West Virginia
Please check back as we update our site as new materials become available.
APS-West Virginia provides comprehensive healthcare management and consultation to WV Department of Health and Human Resources (DHHR). Through this partnership model, APS Healthcare conducts administrative, clinical and coordinating activities for the Bureau for Medical Services, Bureau for Children & Families and the Bureau for Behavioral Health & Health Facilities that result in a more effective and efficient system of care for West Virginia.
As the Administrative Services Organization (ASO), APS assists the West Virginia Department of Health and Human Resources (DHHR) in its development and management of a high quality, accountable, public sector system for an array of programs that include: behavioral health, medical, socially necessary, nursing home pre-admission screening, long term care, Aged & Disabled Waiver and Intellectual/Developmental Disability (I/DD) Waiver.
The APS-WV program includes, but is not limited to, the following functions:
- An effective and efficient process of utilization management
- An established training and consultative process (retro reviews) that encourages
- Improvement in the quality of care;
- Ensuring that care is provided in the most appropriate setting; and
- Increasing successful outcomes.
- Provision of education and technical assistance to providers
- Provision of consumer education which has included
- Annual focus groups;
- Family support and education; and
- Specialized trainings such as Consumer Rights/Responsibilities.
For more information, please call APS - West Virginia at 800-461-0655.
 MEDICAL Providers Online Prior Authorization Submission Implementation
The site for the Direct Data Entry System APS Medical CareConnection® for inpatient hospital services and inpatient rehabilitation <21 WILL NOT go-live on October 17, 2011 and WVMI will continue to accept inpatient requests on their existing system until further notice.
Click here to learn more.
PAS Nursing Home
Please enter through the PARTICIPATING PROVIDERS portal at the left or CLICK HERE.
Attention Dental Providers
As of April 1, 2011 the changes in Chapter 505 Dental Services manual effective 11/1/10 will be in place. To access related materials and information, please enter through the PARTICIPATING PROVIDERS portal at the left or CLICK HERE.
Note: The Bureau for Medical Services has requested that APS Healthcare remind referring providers that the University of Virginia Medical Center will discontinue as an active provider for WV Medicaid on 12/1/10.
Due to the University of Virginia Medical Center closing their relationship with West Virginia Medicaid, members will need to contact their primary care physician (PCP) or their referring physician when needing a referral to another provider/facility that is an active enrolled provider with West Virginia Medicaid Title XIX Program.
If the physician requires assistance to determine enrolled West Virginia Medicaid providers, please refer to our Fiscal Agent, Molina Healthcare at wvmmis@molinahealthcare.com or telephone 1-888-483-0793 and listen to the options before proceeding.
The contact person at West Virginia Medicaid is Nora McQuain, RN, telephone number 304-558-5959.
Hours of Operation: Monday through Friday, 8 a.m. – 5 p.m.
(except for the following eight (8) holidays: New Year’s Day (January 1), Martin Luther King, Jr. Day (3rd Monday in January), Memorial Day (last Monday in May), Independence Day (July 4th), Labor Day (1st Monday in September), Thanksgiving Day (4th Thursday in November), Friday After Thanksgiving (4th Friday in November) and Christmas Day (December 25th.) Any fixed holiday that falls on a Saturday will be observed the Friday before. Fixed holidays that fall on a Sunday will be observed the following Monday.)
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