West Virginia Payer Configuration and Requirements Tables

The payer configuration table is a valuable resource to help you understand the specific requirements for each payer contract as they relate to the integration process. By referencing this table, you can ensure the correct configuration of payer contracts, maintain compliance, and streamline workflows. Use this topic as a quick reference to verify the scope of each payer’s requirements and to facilitate a smooth integration process.

Payer Configurations and Requirements	FFS West Virginia	Aetna	Unicare	The Health Plan	Highmark Health Options West Virginia	WV HHCS
835s Availability	Not in Scope	Not in Scope	Not in Scope	Not in Scope	Not in Scope	Not in Scope
Billing Required	Optional	Not in Scope	Not in Scope	Optional	Not in Scope	Optional
Communications Module Availability	Available	Contact Payer Directly	Contact Payer Directly	Contact Payer Directly	Contact Payer Directly	Available
DX Code is Payer or Provider Managed	State Managed	Payer Managed	Payer Managed	Payer Managed	Payer Managed	State Managed
EVV Required	Required	Required	Required	Required	Required	Required
Payer GPS Tolerance	300 ft	300 ft	300 ft	300 ft	300 ft	300 ft
Missed Visits Required	Required	Required	Required	Required	Required	Required
POC Compliance Required	Not in Scope	Not in Scope	Not in Scope	Not in Scope	Not in Scope	Not in Scope
Rate is Payer or Provider Managed	Provider Managed	Not required	Not required	Not required	Not in Scope	Provider Managed
Referring Physician Required	Not in Scope	Not in Scope	Not in Scope	Not in Scope	Not in Scope	Not in Scope