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Health Care Providers

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 ... Learn more.

Provider Briefing​

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

UHC's Choice Plus network allows access to out of state hospitals to obtain care not available in WV such as​ Johns Hopkins Hospital in Baltimore, Md., the UK HealthCare, clinical arm of the University of Kentucky in Lexington, Ky., and Clevela​nd Clinic in Cleveland, Ohio. 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.​

PEIA Prior Authorization Exemption Gold Card Program

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This Gold Card exemption is subject to internal auditing at any time by UMR and may be rescinded if UMR determines providers are not performing the procedures in conformity with PEIA’s benefit plan based upon the results of UMR’s internal audit.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.​


Prescription Drug Benefits - Prior Authorizations

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.

​Face-to-Face Diabetes Program - Providers and Pharmacists

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 jenny.l.manhart@wv.gov​ for information.​​

Prescription Drug Benefits - Drug Lists​

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​​​​​PEIA Policies 

Policies on weight management, massage, acupuncture and other services ... Learn more.

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    Any questions you may have, please contact UMR at (888) 440-7342. ​