Providers & Partners

Providers & Partners

The first thing physicians discover about West Virginia Senior Advantage (HMO I-SNP) 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 our providers can devote their attention to providing high-quality health care.

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

For your convenience, current Evidenced Base Medical Guideline can be accessed below:

Global Initiative for Chronic Obstructive Lung Disease

Global Initiative for Asthma

American Medical Directors Association Guideline Central

American Diabetic Association

American Heart Association

NIH – U.S. National Library of Medicine


HealthAxis Provider Portal Access

  • The West Virginia Senior Advantage HealthAxis Provider Portal enables providers to:
  • Submit an authorization request
  • Inquire on authorization status
  • Verify member eligibility
  • View member authorization history
  • Check the status of claims/encounter information

If you are a current West Virginia Senior Advantage provider and registered, you may sign-in to use the HealthAxis Provider Portal:

If you are a current West Virginia Senior Advantage provider and would like to register, you may click here: Request Access and follow the prompts to become a Provider Administrator for your participating organization. Noting, a provider organization can only have one Provider Portal Administrator at a time, but may have several Users. If a Provider Administrator is already active, anyone else wanting Provider Portal access must ask their Provider Administrator for it, and they can take the appropriate steps to make that person a User.

Please reach out to for technical support.

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)

  • 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 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, (844) 854-6888 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 as a provider 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 (WVS01) but be aware that each clearinghouse or billing company may have their own unique naming convention for payer IDs. If the clearinghouse has any questions, they can call our technical help desk directly at 1-800-356-0092.
      • Clearinghouse related EDI questions, email

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

West Virginia Senior Advantage

PO Box 21063 Eagan, MN 55121

For questions please contact 1-844-854-6888, TTY 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:

  • The advanced practice clinician (APC) and primary care physician (PCP) care team providing onsite, facility-based support and care;
  • A health risk-assessment tool designed for a senior, nursing facility patient population;
  • A comprehensive history and physical assessment that is utilized to develop an Individualized Care Plan (ICP);
  • A care management platform that helps identify needed preventive health/HEDIS services,  and facilitates care team communications for care coordination; and
  • 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 and 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?

  • From the beginning, physicians discover that West Virginia Senior Advantage isn’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 in our members’/your patients’ quality of life.
  • 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 1-844-854-6888 or email

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