Providers & Partners

Providers & Partners

The first thing physicians discover about West Virginia Senior Advantage (HMO 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.

HealthAxis Provider Portal Access

If you are a current West Virginia Senior Advantage provider, log-in to use the HealthAxis Provider Portal.

The West Virginia Senior Advantage HealthAxis Provider Portal enables providers to submit, track and receive updates on authorizations. In addition, it has an easy to use dashboard which displays announcements, messages, contracted labs, authorization and referral highlights, hospital census data, and activity log details

The HealthAxis Provider Portal allows providers access to:

  • Inquire on authorization status
  • Verify member eligibility
  • View member authorization history
  • Check the status of claims/encounter information

New User Registration

Providers can register a new user through the New User Registration link on the HealthAxis Provider Portal. Providers should select a Provider Administrator within their office to request initial access.

From the main log in page, click on Request Access.

This will take you to a brief message screen where your Provider Administrator will click Continue. After clicking Continue, the new user registration form is shown and needs to be completed and submitted.

 

After submitting the completed form, the access request will be reviewed. Once confirmed your Provider Administrator will receive notification that they now have access to the Provider Portal including directions on how to access their account and the Provider Portal.

Retrieve Password / Reset Password / Retrieve Username

From the main log in page, click on the Forgot Password button

This will take you to the page below where you will enter in your User Name and Email. Your Provider Administrator can also assist you with this.

 

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 Helpdesk_Dallas@ssigroup.com

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 94390 Lubbock, TX 79493

For questions please contact 1-844-854-6888, TTY 711

For Prescribers & Pharmacies

West Virginia Senior Advantage provides Medicare Part D prescription drug coverage through our partner Navitus Health Solutions.

Navitus Health Solutions is a full-service pharmacy benefit management company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.

For Prescribers:

  • Access Formulary and Prior Authorization Forms at www.navitus.com
    • Select “Prescribers” and click on “Prior Authorization”
    • Enter your NPI number and State to access the prescriber portal
  • Navitus Health Solutions Pharmacy Helpdesk
    • Phone number: 1-866-270-3877
    • TTY phone number: 711
  • Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

For Pharmacies:

  • Access payer sheets and other information at www.navitus.com
    • Select “Pharmacies” and click “Pharmacies Login”
    • Enter your NPI number and NCPDP number to access the pharmacy portal
  • Navitus Health Solutions Pharmacy Helpdesk
    • Phone number: 1-866-270-3877
    • TTY phone number: 711
  • Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

Institutional Special Needs Plan Model of Care & Training

At West Virginia Senior Advantage, we specialize in improving health care and advancing a truly 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 PCP support;
  • A risk-assessment tool designed for a senior, nursing facility patient population;
  • A comprehensive history and physical assessment that generates an Individualized Care Plan (ICP);
  • A care management platform that helps identify needed preventive health/HEDIS services, ensures the use of evidence-based clinical guidelines, 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 exception 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