Provider Orientation

WELCOME TO HIGHMARK WEST VIRGINIA!

If you are a newly contracted provider, or a new employee of a network provider's office or facility, we would like to introduce you to the many resources we make available to help you in your interactions with Highmark West Virginia and our members. 

Let's begin with some background on Highmark to help you get to know us:

• History of Highmark
• Highmark's Mission, Vision, and Values

And now to get started working with Highmark, here is what you need to know: 

• All network providers are required to be NaviNet-enabled and must enroll in Electronic Funds Transfer (EFT) within 30 days of NaviNet enablement. For additional details, view:
  • Electronic Transaction Requirements
  • NaviNet Provider Portal
• Electronic Transaction Requirements
• NaviNet Provider Portal
• Provider Resource Center
• Provider Directory
• Highmark Provider Manual
• Provider Communications
• Highmark Products
• Medical Policy
• Claims & Reimbursement
• BlueCard
• Contact Information
• Fraud Prevention

Preventive Health Guidelines

Highmark continually strives to enhance the quality of care and service to our members. One of the ways this is accomplished is via the Highmark Preventive Health Guidelines. The guidelines are reviewed annually and updated to ensure they remain current with national guidelines, as well as with national, regional and local standards of medical care. The guidelines are distributed to the practitioner community as a reference tool to encourage and assist you in planning your patients’ care. Coverage of the preventive/wellness benefits are subject to the terms of the member’s benefit plan.

To help make the information more accessible and convenient for you, the complete set of Preventive Health Guidelines are available here on the Provider Resource Center under EDUCATION/MANUALS. 

Provider Directory

And finally, please be sure to report any changes to us regarding your office, facility, or participating care providers! Visit our Provider Data Accuracy Compliance page for requirements for accurate, up-to-date provider data in our Provider Directory and instructions on how to make any changes to your information on file with us. 

The Provider File Management Guide is included there, too, to assist professional providers in reporting changes via NaviNet. And a link to the Address/Phone Number Change Form for Facility & Ancillary Providers is provided on the page for our participating facilities and ancillary providers. 

Thank you for your support and for providing high-quality care to our members, your patients. Welcome to Highmark West Virginia - we look forward to working with you!

Note: If you are not yet contracted with Highmark West Virginia and are interested in participating in our provider networks, you can start by selecting CREDENTIALING from the main menu on the left, and then choosing the appropriate option based on your provider type. 

You can also find participation information in Chapter 3 of the Highmark Provider Manual . To access the manual, select MANUALS on the Quicklinks Bar located at the top of the Provider Resource Center. Contact Provider Services in your service area with any questions. 

Note: To participate in the Highmark West Virginia Family Health Plan, it is a federal requirement, released by the Centers for Medicaid and Medicare Services (CMS), that providers enroll through DXC Technologies (f.k.a. Molina).  All necessary information must be submitted in order for their enrollment application to be processed making them eligible to serve MCO Medicaid members.

To enroll, please contact the WV Provider Enrollment Department at 888.483.0793 or by email at WVproviderenrollment@molinahealthcare.com. You may also email questions to www.wvmmis.com.