Health Care Providers


Become a Comprehensive Care Provider

PEIA is recruiting physicians for its Comprehensive Care program.

Fee Schedules and Manuals

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

Plan Year 2017

Updates for Plan Year 2017 changes for providers... Learn More.  

Provider Briefing & Provider News

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.

Specialty Care & Out-of-State Referrals

Johns Hopkins Hospital in Baltimore, Md., the UK HealthCare, clinical arm of the University of Kentucky in Lexington, Ky., and Cleveland Clinic in Cleveland, Ohio, 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 HealthSmart Care Management 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 Care Management. Non-emergency care provided outside of West Virginia without approval from HealthSmart Care Management is not covered.

Prescription Drug Benefits