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Medical Services

Registration

New****West Virginia is transitioning to a new web platform for Medical Services called Atrezzo effective 02/01/2022.  Please click here for further information.

New***  Provider Notice: WVCHIP Benefit Transition 2023

Atrezzo Next Generation (ANG)
for Medical Services-Provider Portal

Beginning February 1, 2022, entities seeking approval for medical services will utilize Atrezzo Next Generation (ANG) to submit prior authorization requests. Atrezzo Next Generation (ANG) supports the entire WVCHIP Medical process for clinical determination of services.

Data Submission information and instructions
  • ANG Provider Portal User Guide
  • UM Case View Enhancement Demonstration
  • ANG Provider Portal Quick Reference Guides
    • How to Add Additional Clinical Documentation - Quick Reference Guide FINAL 1.9.2024
    • How to Add Chrome Browser - Quick Reference Guide FINAL 1.9.2024
    • How to View a Determination Letter - Quick Reference Guide FINAL 1.9.2024
    • How to Complete a Saved Request - Quick Reference Guide FINAL 1.9.2024
  • Instructional Videos
    • Adding a Temporary Consumer
    • Submitting Inpatient Request
    • Submitting Outpatient Request
    • Submitting from Consumer  
    • Searching for Determinations
    • Submitting Copy for Correction
    • Submitting copy for new submission
  • MCL Q3 2024 for publish
WVCHIP - Provider Enrollment Registration
  • Atrezzo Portal MultiFactor Registration and Login Process - New External Users FINAL 4.5.2024
  • Provider Portal Registration Overview FINAL 4.5.2024
    • How to Add a User - Quick Reference Guide FINAL 1.23.2024
    • How to Update User Profile - Quick Reference Guide FINAL 1.10.2024
    • How to Reset Password or Unlock Account - Quick Reference Guide FINAL 1.10.2024
  • Provider ADMIN Registration Training Video 
  • Provider ADMIN - ADD and MANAGE Users Accounts Training Video
  • WV Provider Registration FAQs (will be added once document is finalized after all trainings)

WVCHIP Medical Services

Atrezzo Next Generation (ANG) System Information

  • Instructions for Copy for New Submission
  • Instructions for Copy for Correction 
  • Frequently Used Numbers for WVCHIP Updated
  • WVCHIP MCL - Master Code List - 2023

Medical Services Forms and Memos

WVCHIP Prior Authorization Modification Request Form
  • ACENTRA HEALTH WVCHIP Modification form
  • WVCHIP Fax Coversheet
Dental Services
  • ATREZZO WVCHIP PRIOR AUTHORIZATION REQUEST FOR DENTAL
  • WVCHIP Orthodontic Criteria
  • WVCHIP Dental 2019
Durable Medical Equipment (DME)
  • ATREZZO WVCHIP PRIOR AUTHORIZATION REQUEST FOR DME
Home Health
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR HOME HEALTH
Hospice
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR HOSPICE
Inpatient Services - Acute Hospital & Inpatient Rehabilitation <21
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR INPATIENT
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR IP REHAB
Lab/Radiology/Imaging
  • Oncotype DX Request Form-WVCHIP
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR LAB IMAGING RADIOLOGY
Orthotic and Prosthetic Services
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR ORTHOTICS & PROSTHETICS
Out-of-Network Services (WVCHIP Non-Enrolled Providers)
  • WVCHIP OON Request Form
Outpatient Surgery Services
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR OP SURGERY
Podiatry
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR PODIATRY
Private Duty Nursing
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR PRIVATE DUTY NURSING
Therapeutic and Rehabilitation Services
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR PULMONARY REHAB
  • ATREZZO WVCHIP PRIOR AUTHORIZATION REQUEST FOR CARDIAC REHAB
  • ATREZZO WVCHIP PRIOR AUTHORIZATION REQUEST FOR CHIRO
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR SPEECH
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR AUDIOLOGY
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR PT OT
Transportation Services
  • ACENTRA HEALTH WVCHIP TRANSPORTATION
Vision
  • ACENTRA HEALTH WVCHIP PRIOR AUTHORIZATION REQUEST FOR VISION
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1007 Bullitt Street, Suite 200 Charleston, WV 25301

P: (304) 343-9663
Toll Free: (800) 461-0655
F: (866) 473-2354

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