Providers & Partners

Providers & Partners

The first thing physicians discover about West Virginia Senior Advantage (HMO ISNP) is that we aren’t a typical Medicare Advantage health plan. We have a different philosophy, attitude, and approach to caring for our members. Our emphasis is on encouraging proactive health care and offering programs and services that can make a difference for our members’–your patients’–quality of life.

We believe in providing our members exceptional benefits and an abundance of attention. We believe West Virginia Senior Advantage providers deserve the same.

West Virginia Senior Advantage firmly believes that our success as a health plan hinges on our participating providers. We are committed to simplifying the administration of health insurance so that you can devote your attention to providing high-quality health care.

We are always available if questions arise, and we collaborate with you to help ensure the efficient delivery of superior care to our members.

The following clinical practice guidelines are provided as a resource for our network providers to access the most current evidence-based recommendations supporting clinical decision-making. These guidelines are intended solely as educational tools and are not directives for patient care. All patient care and clinical decisions remain the responsibility of the healthcare provider, who must exercise independent clinical judgment based on the individual needs of each patient.

Chronic Kidney Disease

Chronic Pain

Chronic Obstructive Pulmonary Disease (COPD)

Dementia

Depression

Diabetes

Falls

Heart Failure

Preventive Services

Pressure Ulcer

Serious Illness Care/Advance Care Planning

Urinary Tract Infection

Access Health Services Provider Portal

Effective January 1, 2026, Access Health Services began overseeing the West Virginia Senior Advantage provider portal. The provider portal enables providers to do several things including:

  1. Submit an authorization request
  2. Inquire about authorization status
  3. Check the status of claims/encounter information

If you have provider portal access through Access Health Services, you will not have to request additional access.

If you do not have provider portal access through Access Health Services, you must request access by submitting the AHS Provider Portal Access Request form to:

ppmanagement@accesshealthservices.com

For assistance, please contact ppmanagement@accesshealthservices.com .

Electronic Claims Submission (Exchange EDI)

Claims and remittance advices can be submitted and retrieved electronically through your existing clearinghouse or billing company. The following steps will guide you through the process.

EDI (preferred)

      1. The following steps will guide you through the process.
        • You do not need to enroll for electronic claims submission, however, to receive an 835, one of the following must occur:
          • West Virginia Senior Advantage has partnered with VPay® to provide a faster, more efficient way to reimburse your business for services rendered. Payments are distributed via secure fax and settled through your in-office terminal processing functionality, allowing for faster access to each payment. EFT registration will also be available as well as the option to opt out and continue receiving a standard paper check from the Plan. Note that card processing fees will be assessed at the rate outlined in your merchant agreement with your acquiring bank. For EFT, limited transaction fees may apply per the VPay registration agreement.
          • There is no immediate action required in order to receive VCard payments from the Plan; however, to receive faster payments in the future a secure fax number will need to be on file at VPay.
          • Please contact our Customer Service Department, (866) 225-8501 who will connect you directly with VPay for any of the following actions:
            • Add a secure fax number on file
            • Enroll in EFT payments
            • Opt out of electronic delivery and receive paper check payments
            • Enroll to receive 835/Electronic Remittance Advice transmissions through VPay
          • If you are currently using a clearinghouse or billing company, notify them that you wish to submit claims electronically and retrieve remittance advice for the Plan. You can provide the Plan Payer ID (70023) but be aware that each clearinghouse or billing company may have their own unique naming convention for payer IDs. If there are any questions, please contact our Customer Service Department at (866) 225-8501.

Mail (alternative)

If you do not use a clearinghouse or billing company, you can mail your claims to West Virginia Senior Advantage at the address noted below:

Access Health Services
Attn: Claims – West Virginia Senior Advantage
PO Box 3398
Little Rock, AR 72202

For questions, please contact (866) 225-8501, TTY/TDD: 711

Institutional Special Needs Plan Model of Care & Training

At West Virginia Senior Advantage, we specialize in improving health care and advancing a unique philosophy of care to meet the complex needs of the institutional Medicare beneficiary population, while simultaneously streamlining administrative functions for our providers.

The West Virginia Senior Advantage Model of Care focuses on providing a unique level of customized clinical care and services for residents in nursing centers. As we help extend your care, our care model concentrates on addressing each member’s full range of medical, functional, and behavioral health care needs in a coordinated and member-centric manner. This means putting the member’s preferences at the center of the care planning process and leveraging provider resources to ensure every member receives the services necessary to achieve their short- and long-term care goals.

Our model organizes best practices and industry innovations including:

  1. The advanced practice clinician (APC) and primary care physician (PCP) care team providing onsite, facility-based support and care
  2. A health risk-assessment tool designed for a senior, nursing facility patient population
  3. A comprehensive history and physical assessment that is used to develop an Individualized Care Plan (ICP)
  4. A care management platform that helps identify needed preventive health/HEDIS services and facilitates care team communications for care coordination
  5. Frequent face-to-face member and caregiver/family member interactions that identify member care preferences and allow time for important care decision discussions and counseling.

It is important that all of our providers are properly trained and informed about the West Virginia Senior Advantage Model of Care. Our top priority is making sure all of the providers in the West Virginia Senior Advantage network meet the training and education needs of our institutional Medicare beneficiary population. The purpose of the Model of Care Training is to comply with the statutory requirement of the Centers for Medicare & Medicaid Services (CMS), that all Special Needs Plans provide a general understanding of the requirements of the Model of Care. In addition, this will also help you to seamlessly serve West Virginia Senior Advantage members, your patients.

Become a West Virginia Senior Advantage Network Provider

West Virginia Senior Advantage contracts with physicians, facilities and other contracted providers to ensure we have an adequate provider network, which is essential for the delivery of health care services to our members. All providers must be credentialed before they can be added to our network as a participating provider.

Why Partner with West Virginia Senior Advantage?

  1. From the beginning, physicians discover that West Virginia Senior Advantage isn’t a typical Medicare Advantage health plan.
  2. We have a different philosophy, attitude and approach to caring for our members.
  3. Our emphasis is on encouraging proactive health care and offering programs and services that can make a difference in our members’/your patients’ quality of life.
  4. We believe in providing West Virginia Senior Advantage members and providers with exceptional benefits and an abundance of attention.

For more information on becoming a West Virginia Senior Advantage contracted provider, please contact Network Operations at (866) 225-8501 or email WVSA.Contracting@chs-corp.com

PROVIDERS & PARTNERS

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