Important announcements and updates about PEIA health insurance and other services ... Learn more
Become a Medical Home Provider or Comprehensive Care Provider
PEIA is recruiting physicians for its Medical Home and Comprehensive Care programs.
Current fee schedules related to payment for services by PEIA ... Learn more
Policies on weight management, massage, acupuncture and other services ... Learn more
Specialty Care and Out-of-State Referrals
Johns Hopkins Hospital
in Baltimore, Md., and the UK HealthCare
, clinical arm of the University of Kentucky in Lexington, Ky., are preferred providers for out-of-state services not available in West Virginia. Members covered by Plans A, B and C must receive prior authorization from the HealthSmart Network for any out-of-state admission.
Members covered by Plan D, the West Virginia-only plan, can receive only emergency out-of-state care to stablize the patient for transport back to a West Virginia facility. Only a limited number of procedures not available from any West Virginia provider are permitted from out-of-state providers for Plan D members and require prior authorization from the HealthSmart Network. Non-emergency care provided outside of West Virginia without approval from the HealthSmart Network is not covered.
New service providers in West Virginia should complete the Provider Demographic Worksheet
and submit it with a copy of the W-9 form and the practitioner's license to HealthSmart, Attn: Provider Specialty Department, P.O. Box 2451, Charleston, WV 25329-2451.
Prescription Drug Benefits
Read PEIA’s Provider News
, a newsletter for medical providers ... Learn more
The Health Information page includes information about the agency’s Care Management Plans
and workplace wellness programs offered by Pathways to Wellness
. It also includes recommended Web sites for information about health issues and tips for improving health ... Learn more
Fee Schedules & ManualsPreferred Drug List
Go to Forms & Downloads