Provider Enrollment fee - who has to pay?

Who must pay an application fee?                                              

Institutional/facility-type providers newly enrolling in Medicaid or those adding a service location are required to pay an application fee. To determine if your provider type requires an application fee, please refer to the Provider Enrollment Matrix.

Is a fee paid to both Medicare and Medicaid?                                                

No, if you have paid the application fee to Medicare or another State’s Medicaid agency or Children’s Health Insurance Program (CHIP), you will not be required to pay an additional application fee to WV Medicaid. You may be required to provide proof of payment when enrolling with WV Medicaid.

Is the application fee refundable?

The application fee is non-refundable unless it was submitted with one of the following:
? A hardship exception request that is subsequently approved by CMS; or
? An application that is rejected prior to the fiscal agent’s initiation of the screening process.

When must the application fee be paid? If required, the application fee must be submitted with the provider enrollment/revalidation application. To determine when an application fee must be paid, please refer to the Provider Enrollment Matrix. An application fee is required for certain providers when initially enrolling in Medicaid and when those providers add a practice location. You may refer to Understanding the Application Credentialing Fee & Hardship Waiver Request for more information.



How do you apply for a hardship exception?

A provider requesting a hardship exception from the application fee must include, with the
enrollment application, a letter and supporting documentation which describes the hardship
and why the hardship justifies an exception. The hardship exception request and supporting
documentation will be sent to CMS for review and determination of whether to grant the
hardship exception. The WV Medicaid application will be placed on hold, and will not be
considered for enrollment until notification of CMS’ decision on the hardship exception
request is received. For further information regarding the application fee or hardship
exception requests, refer to Understanding the Application Credentialing Fee & Hardship
Waiver Request on the Provider Enrollment webpage at www.wvmmis.com.