Health care providers, who under the state plan and/or state statute are required to be licensed in West Virginia (WV) or the state in which they practice, must maintain and ensure that a current license is on file at all times with the West Virginia Bureau for Medical Services (BMS) Fiscal Agent, Molina. A provider’s participation in the WV Medicaid program may be terminated if Molina cannot verify the current status of a provider’s license.
Effective October 1, 2009, the Provider License Update Reminder Process is as follows:
*** 60 days prior to the license expiration date, an initial reminder letter will be sent to the provider’s correspondence address indicating their current license expiration date. If an updated license is not received on or before the expiration date, the provider will be placed on pay hold.
*** If a provider fails to submit a copy of their updated license 30 days after the expiration date, Molina will check listings from the licensing boards. If a provider’s license renewal date can be verified through the board listings, the pay hold will be re-moved. If Molina cannot verify an effective license renewal date via the board listing, the provider will remain on pay hold.
*** A letter will be sent 30 days after the provider’s license expiration date to providers who have failed to submit their updated license. Molina will not verify license renewal through the licensing boards. The provider will remain on pay hold until the updated license is sent to Molina.
*** 60 days after the license expiration date, Molina will make a telephone call to those providers that have not submitted an updated license. Providers who have failed to send an updated license to Molina will remain on pay hold.
*** 90 days after the license expiration date, Molina will determine which providers have not complied and submitted an updated license. Providers who have not submitted an updated license will receive notification of intent to terminate if the updated license is not received within 30 days.
*** If after 121 days from the initial license expiration date Molina has not received the provider’s updated license, the provider’s claims will be voided from Accounts Payable and the provider will be terminated from West Virginia Medicaid. A letter will be sent to the provider notifying them of the termination. Instructions on how to resubmit claims for payment for services ren-dered by the provider prior to the expiration date will be included in the letter. All other claims will remain voided and not pay-able. A listing of voided claims will accompany the letter.
*** Providers may mail or fax a copy of any license renewal information or other credential/ certification updates prior to expira-tion of the current license. Mailing address: Molina Provider Enrollment, PO Box 625, Charleston, WV 25322. Fax: Provid-er Enrollment 304-348-2763.
*** All providers who have mailed or faxed their updated license will continue their Medicaid enrollment without interruption.
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