Molina Medicaid Solutions
Member Services
(888) 483-0797 or(304) 348-3365
Monday – Friday 8:00 AM – 5:00 PM Provider Services (888) 483-0793 or (304) 348-3360 Monday – Friday 8:00 AM – 5:00 PM Pharmacy Help Desk (888) 483-0801 or (304) 348-3370
Monday – Friday 8:00 AM – 5:00 PM Sunday12:00 PM – 6:00 PM
Access AVRS using same phone numbers 24/7 or visit the website site at www.wvmmis.comPaper Claim Form Mailing Addresses
Form Address City State ZIP CMS 1500 PO Box 3767 Charleston WV 25337-3767 UB 04 PO Box 3766 Charleston WV 25337-3766 ADA 2006 PO Box 3768 Charleston WV 25337-3768 NCPDB UCF PO Box 3765 Charleston WV 25337-3765 Reversal/Replacement PO Box 3767 Charleston WV 25337-3767 Timely Filing PO Box 2002 Charleston WV 25337-2002
Situational Documentation
Form Address City State ZIP Hysterectomy, Sterilization & Pregnancy Termination PO Box 2254 Charleston WV 25328-2254
Bureau for Medical Services
Long Term Care (304) 352-4241 Third Party Liability (304) 558-1700 Medicare Buy-In (304) 352-4295 Case Planning Unit (304) 558-1776 Fax KEPRO-Utilization Management Contractor (UMC)Long Term Care Aged and Disabled Waiver (ADW) Phone Number 844-723-7811 FAX Number 866-212-5053 General Email [email protected] Additional Information for PAS [email protected] Submit Re-evaluation MNER requests https://wvltc.kepro.com Intellectual/Developmental Disabilities Waiver (I/DDW) Phone Number 866-385-8920 or 304-380-0617 FAX Number 866-521-6882 General Email [email protected] Submit additional information for prior authorization (PA) requests Submit requests for prior authorization https://wvltc.kepro.com Personal Care Phone Number 844-723-7811 FAX Number 866-212-5053 General Email [email protected] Submit requests for prior authorization https://wvltc.kepro.com Nursing Facility Phone Number 844-723-7811 FAX Number 844-633-8425 General Email [email protected] Submit requests https://c3kepro.com/cms/main Medical Services Phone Number FAX Number 866-209-9632 Email [email protected] ORG Managers: C3 Care Connection Enrollment AUM Managers: C3 Care Connection Provider Portal General Medical Information [email protected] Medical Form FAX Numbers Bariatric, Inpatient, Inpatient Rehab Under 21, Organ Transplants 844-633-8426 Outpatient Surgery 844-633-8427 Imaging/Radiology, Laboratory 844-633-8428 Cardiac & Pulmonary Rehab, Durable Medical Equipment, Orthotics and Prosthetics 844-633-8429 Home Health, Hospice, Private Duty Nursing 844-633-8430 Audiology/Speech, Chiropractic, Dental/Orthodontics, Podiatry, Vision, PT/OT 844-633-8431
Carrier List Carrier Listing by Name Click Here Disproportionate Share Hospital Survey SFY 2014 DSH Survey Form Click Here