Medical Billing Services in West Virginia
West Virginia’s Medicaid program is managed care for most members, but with carve-outs that change where a claim should go. Pharmacy, long-term care, waiver services, and medical transportation are paid fee-for-service directly by the state, while everything else runs through one of four managed care organizations. A billing team that routes every West Virginia claim to the MCO will watch the carved-out ones deny, and a team that routes everything fee-for-service will miss the managed care majority.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for West Virginia practices of every specialty, built around the state’s actual payers and programs.
West Virginia’s payer landscape
West Virginia Medicaid managed care is called Mountain Health Trust, covering roughly 87 percent of the state’s Medicaid membership, including most adults and children, pregnant women, and SSI recipients. It is delivered through four managed care organizations: Aetna Better Health of West Virginia, The Health Plan, Highmark Health Options of West Virginia, and Wellpoint West Virginia. Members choose an MCO at enrollment and may change plans.
Services carved out of managed care and paid fee-for-service directly include point-of-sale pharmacy, long-term care, Home and Community-Based Services waivers, and non-emergency medical transportation. Those claims follow state fee-for-service rules, not MCO rules, and routing them correctly from the start is what keeps them out of the denial queue.
Commercial coverage runs through Highmark, The Health Plan, Aetna, and UnitedHealthcare. Medicare Part B claims run through Palmetto GBA, Jurisdiction JM, and Medicare Advantage plans add their own prior authorization rules on top of the Mountain Health Trust and commercial mix.
What MedPlus RCM handles for West Virginia practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Mountain Health Trust plans, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Charleston, Huntington, Morgantown, Parkersburg, Wheeling, and Beckley, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results West Virginia practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
What is Mountain Health Trust?
Mountain Health Trust is West Virginia’s Medicaid managed care program, covering most adults and children, pregnant women, and SSI recipients through four MCOs.
Do you work with Mountain Health Trust plans?
Yes. We bill Aetna Better Health of West Virginia, The Health Plan, Highmark Health Options of West Virginia, and Wellpoint West Virginia, as well as commercial and Medicare plans.
What services are carved out of managed care?
Point-of-sale pharmacy, long-term care, Home and Community-Based Services waivers, and non-emergency medical transportation are paid fee-for-service directly by the state, not through the MCOs.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your West Virginia practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
