WV Bureau for Medical Services: Statutory mandated use of prior authorization portal effective July 1, 2024
Memo
- WV Behavioral Healthcare Providers Association
- WV Chiropractic Society
- WV Healthcare Association WV Hospital Association WV Nurses Association
- WV Osteopathic Medical Association WV Physical Therapy Association WV Primary Care Association
- WV Rural Health Association WV State Medical Association
CC: Office of the Insurance Commissioner WV Bureau for Medical Services
From: Ben Beakes, Executive Director WV Association of Health Plans
(Members: Aetna Better Health of WV, The Heath Plan, UniCare of WV)
Date: April 18, 2024
Subject: Statutory mandated use of prior authorization portal effective July 1, 2024
During the 2023 Regular Session of the West Virginia Legislature, the Legislature passed, and the Governor signed into law, Senate Bill 267 – updating law regarding prior authorizations. The legislation made several changes to prior authorization standards and set several mandates to which insurers must adhere.
However, among the requirements was one mandate placed upon providers – it requires all providers to submit all prior authorizations via the insurers’ electronic portal beginning July 1, 2024. It is important to note that although this memo outlines the code section relating to managed care companies, the legislation outlined the same mandate in the respective sections of code relating to all types of insurance companies, including PEIA. Specifically, the code states:
- 33-25A-8s(b): “The health maintenance organization shall require prior authorization forms, including any related communication, to be submitted via an electronic portal and shall accept one prior authorization for an episode of care. These forms shall be placed in an easily identifiable and accessible place on the health maintenance organization’s webpage and the portal web address shall be included on the insured’s insurance card.”
WVAHP Memo Page 2 of 2
After consultation with the Office of the Insurance Commissioner, it has been determined that the code does in fact require insurers to only accept prior authorizations via the electronic portal effective July 1, 2024. Unless we are advised otherwise or the legislature changes the statutory requirement, all other forms of prior authorization submittal that are not via the electronic portal cannot be accepted.
Provider portal web addresses for the Medicaid MCOs are as follows:
Aetna Better Health of WV:
https://apps.availity.com/availity/web/public.elegant.login
The Health Plan:
UniCare of WV:
https://apps.availity.com/availity/web/public.elegant.login
The members of the WV Association of Health Plans understand that for many providers this is a significant change in practice. If you need assistance with the electronic portal, please contact each MCOs’ provider relations teams.
Aetna Better Health of WV
The Health Plan:
https://www.healthplan.org/providers/overview/meet-practice-management-consultant
UniCare of WV:
https://www.provider.unicare.com/west-virginia-provider/contact-us/email
