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Frequently Asked Questions about UMR, PEIA's new TPA

View the most frequently asked questions about PEIA's transition to our new TPA, UMR.
UMR FAQ

Important information about claims prior to July 1, 2019

Become a Comprehensive Care Provider

PEIA is recruiting physicians for its Comprehensive Care program.

Fee Schedules and Manuals

Current fee schedules related to payment for services by PEIA ... Learn more.

Provider Briefing & Provider News

New Providers

New service providers in West Virginia should complete the Provider Demographic Worksheet and submit it with a copy of the W-9 form and the practitioner's license. The information can be emailed directly to UMR at westvirginiapeia@umr.com.

Specialty Care & Out-of-State Referrals

Johns Hopkins Hospital in Baltimore, Md., the UK HealthCare, clinical arm of the University of Kentucky in Lexington, Ky., and Cleveland Clinic in Cleveland, Ohio, are preferred providers for out-of-state services not available in West Virginia. Members covered by Plans A, B and C must receive prior authorization from UMR for any out-of-state admission.

Members covered by Plan D, the West Virginia-only plan, can receive only emergency out-of-state care to stabilize the patient for transport back to a West Virginia facility. Only a limited number of procedures not available from any West Virginia provider are permitted from out-of-state providers for Plan D members and require prior authorization from UMR. Non-emergency care provided outside of West Virginia without approval from UMR is not covered.

Prescription Drug Benefits