All providers must submit PA via electronic portal by July 1, 2024. PEIA has a 1/1/24 on this directive.
Fee Schedules and Manuals
Current fee schedules related to payment for services by PEIA ...
In accordance with WV House Bill 2351, the Gold Card program was designed to allow six months of exemption from seeking prior authorization for providers who meet specific requirements. To keep Gold Card status continuously, providers will need to submit clinical documentation for services performed during their Gold Card period for monitoring by UMR. As long as all requirements are met, Gold Card status can be renewed every six months.This Gold Card exemption is subject to internal auditing at any time by UMR and may be rescinded if UMR determines providers are not performing the procedures in conformity with PEIA’s benefit plan based upon the results of UMR’s internal audit.For more information, or to check the status of a Gold Card, please contact UMR at (888) 440-7342.
Prior authorizations for non-specialty medications are handled by the Rational Drug Therapy program at WVU (1-800-847-3859).
Prior authorizations for specialty medications are divided into two categories:
1. Patient self-administered specialty meds are covered under the prescription drug benefit and prior authorizations are handled by Express Scripts call 1-800-803-2523, fax 1-888-302-1028, or e-prescribe the specialty drug to the Accredo Specialty Pharmacy.2. Healthcare provider-administered drugs are covered under the medical benefit, and the prior authorization process is handled by UMR call 1-888-440-7342.
PEIA’s Face-to-Face (F2F) Diabetes Program is always looking for new providers. If you are a pharmacist who wishes to participate with the program by offering valuable counseling to our members, but you are not certified through APhA’s The Pharmacist & Patient-Centered Diabetes Care, please contact PEIA’s Face-to-Face Diabetes Program Manager, Jenny Manhart at firstname.lastname@example.org for information.
Policies on weight management, massage, acupuncture and other services ...