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.
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do
Medical Billing Popular Articles
Procedure code and Description 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A pro...
• G0502: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager...
Hyperlipidemia Hyperlipidemia (hyperlipemia) involves abnormally elevated levels of any or all lipids and/or lipoproteins in the blood. Hy...
HCPCS Codes Effective for claims with dates of service on June 30, 2011, Medicare providers shall report one of the following HCPCS codes...
Generally speaking, when we say 'objective measures,' what does that mean? Answer: Objective measures consist of standardized p...
Q: My patient enrolled in a Medicare Advantage (MA) plan during the middle of the inpatient hospital stay. Who should I bill? A: When a p...
Its often confused that BCBS have lot of prefixes and where to contact. However we have some guide to follow, using prefixes we could find t...
Denial code co - 45 - Charges exceed your contracted/legislated fee arrangement. Note: This adjustment amount cannot equal the total servic...
1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent with the modifier used or a required mo...
1) Aetna: 120 days . 90 Days 2) Amerigroup: 180 days. 3) Bcbs: 1yr . 180 days updated. 4) Cigna: 180 days. 5) Humana: 15 mon...