Providers

Announcements

Important announcements and updates about PEIA health insurance and other services ... Learn more.

Want to become a Medical Home Provider?

PEIA is recruiting physicians for its Medical Home Program. Complete the Medical Home Provider Enrollment Form ... Learn more.

Fee Schedules

Current fee schedules related to payment for services by PEIA ... Learn more.

PEIA Policies

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 ActiveHealth 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 ActiveHealth. Non-emergency care provided outside of West Virginia without approval from ActiveHealth is not covered.

• Johns Hopkins Hospital (1-855-695-4872, jhusa@jhmi.edu)
• UK HealthCare (UKMDs Physician-to-Physician line 1-800-888-5533, ukhealthcare.uky.edu, West Virginia Physician Liaison: linda.hays@uky.edu)

Hospitals

Policies for hospital stays and related issues ... Learn more.

Medical Providers

PEIA fee schedules, policies and related issue ... Learn more.

New Providers

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

• High-Performance Preferred Drug List (Plans A, B, C and D)
• High-Performance Preventative Drug List (Plan C)
• Retail Maintenance Network
• Maintenance Medications List
• Common Specialty Medications
• Case Managed Drugs
• Prior Authorizations /Drugs with Special Limitations

Provider News

Read PEIA’s Provider News, a newsletter for medical providers ... Learn more.

Health Information

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.

Popular Downloads

Fee Schedules & Manuals
Preferred Drug List

Go to Forms & Downloads