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West Virginia - Medicaid Managed Care

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Provider Resources

If you're a provider of UniCare Health Plan of West Virginia, Inc. and would like information on plans, benefits, claims, providers or any other customer service topic, please call us at 1-800-782-0095. You also can call our Community Resource Center toll-free at 1-888-611-9958 and speak with our staff dedicated to serving our providers. As an additional resource, here is a list of Important Contact Information.  
The following resources are available to our providers: 
ICD-10 Updates  

Quality Improvement Program 
Date 
Format 
Provider education: provider remittance updates  
  
PDF 
HEDIS Benchmarks and Coding Guidelines For Quality Care  
  
PDF 
Behavioral health review outlines  
07/14/17 
PDF 
PPC HEDIS Reference Guide 
    
Quality Measures desktop reference for Medicaid Providers 
  
PDF 
Medical Records Documentation Standards 
11/13 
PDF 
Information about our Quality Improvement Program 
  
PDF 
Get Ready for HEDIS! 
01/10 
PDF 
HEDIS® Descriptions 
09/09 
PDF 
20 Principles of Customer Care 
10/06 
PDF 
Clinical Practice Guidelines 
    
Preventive Health Care Guidelines 
    
Behavioral Health Clinical Practice Guidelines 
    
     
Authorization and Preservice Review 
Date 
Format 
Behavioral Health and Substance Use Disorder Authorization Request Form  
11/07/19 
PDF 
Discharge Planning Form  
05/22/19 
PDF 
UM Toolkit 
    
Precertification Look UP Tool (PLUTO) 
    
Request for Authorization 
09/23/19 
PDF 
Clinical Utilization Management (UM) Guidelines 
  
PDF 
     
BH Authorization Forms 
Date 
Format 
Behavioral Health and Substance Use Disorder Authorization Request Form  
11/07/19 
PDF 
Request for Residential Treatment Center Services  
    
Initial Authorization Request  
    
Outpatient Treatment Authorization Request  
    
Continued Stay Form  
    
Discharge Summary  
    
     
Health Education 
Date 
Format 
Improving the Patient Experience CME  
    
My Diverse Patients  
    
My Diverse Patients Training: Breast Cancer Screening for African American Women  
    
My Diverse Patients Training: Creating an LGBT-Friendly Practice  
    
My Diverse Patients Training: Reducing Health Care Stereotype Threat  
    
Moving Toward Equity in Asthma  
    
Pediatric Preventive Care 
07/21/16 
PDF 
Cultural Competency Training 
  
PDF 
Caring for Diverse Populations 
03/19 
PDF 
Diabetes Resources for Patients and Providers 
    
Disease Management Centralized Care Unit 
    
Employee Language Skills Self-Assessment Tool 
09/17/12 
PDF 
EPSDT Information 
    
Health Education Programs: Programs To Keep You Well 
    
Interpreter Services 
    
Interpreter Services Desktop Reference 
  
PDF 
     
Provider Communications 
Date 
Format 
Medicaid Provider Workshops 
    
Provider Newsletters 
    
Provider Manual and Important Updates 
    
     
Availity  
    
New pregnancy notification process using the Availity Portal Benefit Look-Up Tool  
09/19/19 
PDF 
Remittance Inquiry through Availity tips  
12/27/17 
PDF 
     
Additional Services and Programs 
Date 
Format 
New case management program for PTSD in the neonatal intensive care unit  
07/14/17 
PDF 
Pharmacy information 
    
Primary Care Coordination 
    
     
Tonsillectomy in Children 
Date 
Format 
Pediatric Throat Infection Tracker Form 
10/12 
PDF 
Tonsillectomy PCP Checklist Form 
10/12 
PDF 
     
Forms and Tools 
Date 
Format 
Electric, Nonhospital Grade Breast Pump Request Form  
09/19/19 
PDF 
Overpayment Refund Notification Form  
03/27/18 
PDF 
Benefit Matrix for Adults 
07/24/17 
PDF 
Benefit Matrix for Children 
07/24/17 
PDF 
Coordination of Care Form and Letter Templates 
    
McKesson ClaimsXtenTM Rules 
08/12 
PDF 
Acronyms and Definitions 
02/13 
PDF 
Tour Our Provider Website for the Latest Information 
10/12 
PDF 
Forms Library 
    
Desktop IVR Reference Guide 
03/09 
PDF 
How to Find Preventive Care Forms Online 
02/13 
PDF 
Member Handbook/Evidence of Coverage (PDF) 
  
PDF 
Provider Directory 
  
PDF 
Member Rights and Responsibilities
Please refer to the Provider Manual, Chapter 21: Member Rights and Responsibilities 
  
PDF 
     
Behavioral Health 
Date 
Format 
NAS Provider Toolkit  
09/18/18  
PDF 
Developmental, psychological and neuropsychological testing FAQ  
    
West Virginia Behavioral Health Provider Manual 
    
Psychological Testing Request Form  
    
Neuropsychological Testing Request Form 
    
Alzheimer’s Mini-Cog Screening 
  
PDF 
Functional Activities Questionnaire 
  
PDF 
Audit Alcohol Use Questionnaire 
  
PDF 
CRAFFT Adolescent SUD Screening 
  
PDF 
SBIRT Screening Tools  
    
Assist SUD Screening 
  
PDF 
CAGE-AID SUD Screening 
  
PDF 
Michigan Alcohol Screening Test (MAST) 
  
PDF 
Mood Disorder Questionnaire Bipolar Disorder Screening 
  
PDF 
PHQ-9 Depression Screening 
  
PDF 
Pediatric Symptom Checklist 
  
PDF 
Vanderbilt Assessment Scales ADHD Screening 
    
     
Policies, Manuals and Guidelines 
Date 
Format 
Medicaid Reimbursement Policies 
    
Advance Directives 
  
PDF 
Notice of Privacy Practices 
  
PDF 
     
Recruiting and Contracting Materials 
Date 
Format 
Health Care Delivery Organization Application  
07/14/17 
PDF 
Summary of Credentialing Program 
04/10 
PDF 
CMS Ownership Disclosure Form 
01/10 
DOC 
Why UniCare 
09/09 
PDF 
CAQH Credentialing and Application Information 
06/08 
PDF 
     
     
 
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