Traumatic Brain Injury Waiver
The Traumatic Brain Injury (TBI) Waiver Program is a long-term care alternative, which provides services that enable individuals to live at home rather than receiving nursing facility care. The program provides home and community-based services to West Virginia residents who are medically and financially eligible to participate.
Acentra Health, contracted by the Bureau for Medical Services (BMS) is responsible for the day-to-day operations and oversight of the TBI Waiver program. This includes conducting the evaluations that determine medical eligibility for applicants and members, performing provider agency certification and quality/utilization reviews, reviewing requests for prior authorization, providing training and technical assistance to all stakeholders and reviewing requests for prior authorization of TBI Waiver services.
Atrezzo for Traumatic Brain
Injury (TBI) Waiver
Beginning May 3, 2021, TBI Waiver Case Management Providers will utilize Atrezzo Next Generation (ANG) to submit Member’s Service Request. In addition, TBI Waiver Providers and/or PALCO who are assigned to an applicant/ member will be able to access and review applicant/member’s case records including the completed Pre-Admission Screening (PAS), the applicable Rancho scale used to determine initial and reevaluation medical eligibility; medical eligibility determination letters; and Selection and Service Delivery Model (SDM), to name a few. Assigned TBI Waiver Providers and/or PALCO will have the capacity to review and download attached documents and letters from the Member’s Case records for their files.
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- Atrezzo TBI Waiver PPL Training 04.15.2021
- Atrezzo TBI Waiver - How to submit a UM Request
- Provider Admin Registration Training Video
- Provider Admin Add & Manager User Accounts Training Video
- Atrezzo Provider Portal - Add Documentation and View Determination Letters
- Atrezzo Provider Portal - How to Complete a Saved Request
- Atrezzo Provider Portal - How to Submit a New Request
- Atrezzo Provider Portal - WV TBIW Create Case Wizard Enhancement
- WV TBIW Atrezzo Provider Portal System Training
Consumer Education Goals
Acentra Health staff is available for training and technical assistance and to receive complaints about TBI Waiver service provision.
- Empowering persons receiving services with information about their rights and responsibilities in communicating with providers and a utilization management contractor
- Informing people of their rights and responsibilities within the TBI Waiver program
- Informing people of their role/choice in accessing services through Waiver versus an institution, choice in service delivery model, and service providers
- Serving as a resource to assist consumers, families, providers and stakeholders with information about alternative resources, advocacy, transitional living homes, food pantries and more.
- Disability Rights of West Virginia
- Center for Excellence in Disabilities at West Virginia University
- US Department of Justice and Civil Rights Division Americans with Disabilities Act
- US Department of Education Individuals with Disabilities Education Act
- West Virginia Department of Health and Human Resources
- Brainline
- National Resource Center for Traumatic Brain Injury
- Brain Injury Association of America
Provider Education Goals
Acentra Provider Educators and other UMC staff are available for training and technical assistance to TBI Waiver providers.
- Educating providers about their duties to consumers, families and other stakeholders
- Completing on-site utilization management and quality outcomes reviews to gather data and provide training/technical assistance to improve the quality of service documentation, services provided and consumer outcomes
- Assisting providers with proper submission of requests for prior authorization
- Educating providers about TBI Waiver policy
TBI Waiver Department Contacts
Phone: 866.385.8920
Fax: 866.607.9903
General Email: WVTBIWaiver@acentra.com
Additional Resources
Bureau for Medical Services
350 Capitol Street
Charleston, WV 25301
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(304) 558-1700
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Fax: (304) 558-4398
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Claims Processing
Gainwell Technologies
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For Providers: (888) 483-0793
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For Members: (304) 343-3380
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Fax: (304) 348-3380
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West Virginia Protective Services
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dashicons-admin-site-alt3 http://www.dhhr.wv.gov/