Medical Services

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.

Spring 2022 Workshop Presentation
Spring 2021 Workshop Presentation

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. ANG supports the entire West Virginia Medical process for clinical determination of services. ANG’s capability to auto-adjudicate means submitters will often receive an immediate response upon the submission of certain Medicaid services, such as Initial physical/occupational therapy and chiropractic requests.

Data Submission Information and Instructions

ANG Provider Portal User Guide
UM Case View Enhancement Demonstration
ANG Provider Portal Quick Reference Guides
Instructional Videos

Medical Services - Provider Enrollment Registration

ANG Provider Portal Administrator Registration Training
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)

Medical Services Forms and Memos

Authorization Requests Submission and Timeframes

Acentra Health UM Submission and Timeframes
BH and Medical Leniency Process
Acentra Health Modification Form-WV Medical
Medical Fax Coversheet

Dental Services

Dental Services Prior Authorization Request Form
Orthodontic Criteria Form

Durable Medical Equipment (DME)

DME Prior Authorization Request Form
CMN for DME
COST CALCULATION FORM

Home Health

Home Health Services Prior Authorization Request Form

Hospice

Hospice Services Prior Authorization Request Form

Inpatient Services - Acute Hospital & Inpatient Rehabilitation <21

Inpatient Rehab Prior Authorization Request Form
Inpatient Prior Authorization Request Form

Lab/Radiology/Imaging

Laboratory/Genetic Testing Prior Authorization Request Form
Radiology/Radiation Prior Authorization Request Form
Oncotype DX Request Form WV

Orthotic and Prosthetic Services

Orthotic/Prosthetic Services Prior Authorization Request Form

Outpatient Surgery and Physician Administered Drugs

Outpatient Surgery Prior Authorization Request Form
Physician Administered Drugs Prior Authorization Request Form

Out-of-Network Services

Out of Network Prior Authorization Form

Podiatry

Podiatry Prior Authorization Request Form

Private Duty Nursing

Private Duty Nursing Prior Authorization Request Form

Therapeutic Services - Physical & Occupational Therapy ~ Speech & Audiology ~ Cardiac & Pulmonary Rehabilitation ~ Chiropractic

Pulmonary Rehab Prior Authorization Request Form
Cardiac Rehab Prior Authorization Request Form
Chiropractic Prior Authorization Request Form
Speech Prior Authorization Request Form
Audiology Prior Authorization Request Form
PT/OT Prior Authorization Request Form

Vision

Vision – Adult - Prior Authorization Request Form
Vision Form – Under 21 - Prior Authorization Request

Provider Manuals and instructions

Atrezzo Next Generation (ANG) System Information

ANG Provider Portal User Guide
Instructions for Copy for New Submission
Instructions for Copy for Correction
Frequently Used Numbers-Medical
MCL Q1 2025
PHYSICIAN ADMINISTERED DRUGS.08082024