Is UniCare still a West Virginia Medicaid plan?

No. UniCare Health Plan of West Virginia became Wellpoint on January 1, 2025, a year after the same rebrand hit other states. Provider agreements, contracts and reimbursement did not change. The state lists the plan as Wellpoint of West Virginia. Older cards, rosters and even body copy on Wellpoint's own West Virginia page still say UniCare, so a directory that says UniCare is stale rather than wrong about which plan it means.

Which behavioral health vendor do I apply to in West Virginia Medicaid?

None. There is no behavioral health carve-out vendor for a regular Mountain Health Trust member. The plan that administers the medical care administers the psychiatric visit too. The carve-out here is by population rather than service: Mountain Health Promise moved children and youth in foster, kinship and adoptive care, plus the CSED waiver, to a single statewide plan run by Aetna Better Health of West Virginia.

West Virginia

West Virginia Behavioral Health Credentialing and Medicaid Enrollment

Q: How fast is Medicaid enrollment in West Virginia now?

House Bill 4335, passed February 20, 2026, requires the department or its agent to complete enrollment determinations within five business days of a completed application, effective July 1, 2026, with electronic notice within two business days when documentation is missing. Five business days is not in the same universe as the 60 to 120 days that is normal elsewhere. It is brand new law, so the plans and the fiscal agent are still settling into it, and the clock only runs on a genuinely completed application.

Q: Can I see patients while a West Virginia carrier credentials me?

State law and payer policy pull in different directions here, so read both. W. Va. Code 33-45-2(a)(11) gives an insurer four months to accept or reject a completed application and says a provider who provides services during the credentialing period shall be paid, with overpayments recoverable if credentialing ultimately fails. But Highmark tells providers not to treat members before credentialing finishes. Treat the statute as a payment right, not a green light.

Q: Do prescribers who never bill West Virginia Medicaid still have to enroll?

Yes. Prescribers serving Medicaid members must be enrolled and their name and NPI must appear on the pharmacy claim. Pharmacy is fee-for-service in West Virginia, so that reaches you through the state even when your patient is in a plan. There is an ORP-only route for prescribers who will not bill directly, and the state has said a completed ORP-only application can be enrolled in about five days.

Q: Why does my Highmark credentialing clock change if I practice near Ohio?

Highmark West Virginia's own network access plan says initial credentialing happens within 120 days of a completed application, citing the West Virginia statute, but 90 days if your primary practice site is in Ohio, because Ohio's healthcare simplification law reaches it. For a Northern Panhandle practice a few miles from the border, which side of the river your office sits on changes your clock by a month.

Q: Do you need my CAQH password?

No, and we will not ask. We are added as an authorized practice manager, which lets us keep your practice data current and authorize each payer. You complete and attest your own profile. West Virginia leans on CAQH harder than most states and Highmark calls it its exclusive credentialing system, so one stale attestation can stall every application at once.

West Virginia just legislated the fastest enrollment clock in the country. A law passed in February 2026 gives the state five business days to decide a completed Medicaid enrollment, and gives a Medicaid plan 60 days to finish credentialing or you are credentialed anyway. The commercial side has had a four-month clock and a pay-during-credentialing rule for years. The trap here isn’t the timelines. It’s the names.

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West Virginia payers and timelines

The West Virginia rule worth knowing

Five business days on Medicaid. Sixty days at the plan, or you’re credentialed by default.

House Bill 4335 passed on February 20, 2026 and took effect on passage. By July 1, 2026 it requires the department or its agent to complete enrollment determinations within five business days of a completed application, and to notify you electronically within two business days when documentation is missing.

On the plan side it requires a Medicaid managed care organization to finish credentialing within 60 calendar days of a clean and complete application, with one 30-day extension available only on written justification. The penalties behind that include corrective action, monetary sanctions, or credentialing by default. It also directs the Offices of the Insurance Commissioner to prescribe the CAQH credentialing form, bars a Medicaid plan from using a different form or demanding information beyond it, and makes electronic submission the only accepted method from July 1, 2026.

Two honest notes. This is brand new law, so expect the plans and the fiscal agent to still be settling into it, and we confirm rather than assume. And the same act repealed West Virginia’s old uniform credentialing article as duplicative, so if a checklist or a competitor cites that article at you as the state’s credentialing law, it’s citing dead text. Every section of it now reads as repealed.

The commercial side already had a clock. W. Va. Code 33-45-2(a)(11) requires an insurer to complete a credential check and accept or reject a new provider within four months of the completed application, extendable by three more only for primary source verification delays, and it requires the insurer to publish the list of everything the application must contain. It also says a provider who provides services during the credentialing period shall be paid for them, while letting the insurer recover overpayments if credentialing ultimately fails. Here’s the tension you need to know about: Highmark tells providers not to treat members before credentialing completes. So the statute is a payment right, not a green light, and a provider who reads only the law could take a risk the carrier’s own policy warns against.

Credentialed›contracted›loaded›connected›payable

West Virginia shortened the first box by statute. It did nothing to the other four, and a five-day enrollment doesn’t help if the plan contract behind it hasn’t been signed. That’s the part we work.

Two tracks

One state enrollment, four plans, and no behavioral health vendor to chase.

West Virginia is smaller and more concentrated than most states, and that works in your favor. Roughly 87 percent of Medicaid membership sits in Mountain Health Trust managed care, and behavioral health sits inside those same plans.

West Virginia Medicaid

Enroll in PEAP, then contract with four plans.

Enrollment runs online through the Provider Enrollment Application Portal on the fiscal agent’s site at wvmmis.com. There are two doors: enroll as a billing provider if you’ll submit claims, or ORP-only if you won’t. Every enrolling provider signs a Provider Agreement, and an electronic signature is accepted.

File the ORP enrollment earlyPrescribers serving Medicaid members must be enrolled, and their name and NPI must appear on the pharmacy claim. Pharmacy is fee-for-service here, so that rule reaches you through the state even when your patient is in a plan. The state has said a completed ORP-only application can be enrolled in about five days, so it protects your patients’ prescriptions while a billing enrollment is still moving.

The four plans

Aetna Better Health of West VirginiaThe Health Plan of West VirginiaWellpoint West VirginiaHighmark Health Options West Virginia

The carve-out is by population, not serviceMountain Health Promise, a 1915(b) program effective March 1, 2021, moved children and youth in foster, kinship and adoptive care, plus the CSED waiver, to one statewide plan run by Aetna Better Health of West Virginia. If you see kids in the child welfare system, that’s the relationship that reaches them.

Newest plan, newest questionsHighmark Health Options was approved in January 2024 and started covering members August 1, 2024. It’s a separate contract from Highmark’s commercial line despite the shared brand, so we confirm its current behavioral health network needs rather than assuming.

RevalidationAt least every five years, with notice when you’re scheduled and termination for non-response. If Medicare or another state’s Medicaid screened you in the previous five years, West Virginia may accept part of that screening.

Commercial

CAQH does statewide work here, so one lapse stalls everything.

The Offices of the Insurance Commissioner point West Virginia insurers and providers at the CAQH provider data portal as a one-stop route, and the 2026 law puts a CAQH-based standard form back on a statutory footing for Medicaid plans. Highmark goes further and names CAQH its exclusive credentialing system.

Highmark changed platformsSince November 3, 2025, Highmark runs professional and organizational credentialing for West Virginia, Pennsylvania and New York through CertifyOS. You still register with CAQH, you still start with Highmark’s Initial Credentialing Request Form, and at the end of that form you click through to the Certify intake portal. Guides written before that date send you to the wrong place.

Behavioral health doorsHighmark credentials behavioral health practitioners itself. UnitedHealthcare routes it to Optum through Provider Express. Cigna routes it to Evernorth. Aetna keeps it in-house but on a separate behavioral request form.

Seeing patients in other statesAetna, Cigna and UnitedHealthcare are national, so one contract each. One Highmark West Virginia contract reaches Blue members in other states through BlueCard when you’re licensed there. The gate is the license, not another contract. Medicaid is the real exception and it doesn’t travel.

Self-funded plans sit outside the statuteThe four-month clock works through provider contracts with regulated insurers, so a self-funded employer plan gets nothing from it. That matters more here than in most states, because of PEIA.

West Virginia commercial payers

A short list, and one of them decides whether your schedule fills.

The four-month statutory ceiling applies to the regulated commercial lines. Treat published figures as ceilings and standards, not expected turnaround, and confirm at submission.

Highmark Blue Cross Blue Shield West Virginia

The dominant commercial payer in the state

Published standard: initial credentialing within 120 days of a completed application, citing the West Virginia statute. 90 days if your primary practice site is in Ohio, under Ohio’s healthcare simplification law
Behavioral health: credentialed by Highmark itself, no outside behavioral vendor
One effort, two books: the PPO network is the same network the individual direct-pay EPO plans use, so one credentialing effort reaches group and individual members
Sequence: credentialing finishes before the contract effective date, and Highmark says not to treat members before it does

The Health Plan of West Virginia

The Wheeling local payer with real reach

Usually: about 60 to 120 days from a complete application
Four books, four contracts: commercial, Medicare Advantage, Mountain Health Trust Medicaid, and a large self-funded administration book across West Virginia and eastern Ohio
Step people miss: an already-contracted group adding a clinician goes through the Credentialing Request Form inside the secure provider portal, not the public join-the-network form. Use the wrong one and you wait on nothing
Check the domain: the West Virginia payer is at healthplan.org. The similar name at thehealthplan.com belongs to a Pennsylvania organization

UnitedHealthcare

Behavioral health goes through Optum

Usually: about 60 to 120 days from a complete application
Bigger here than market share suggests: UMR, a UnitedHealthcare company, administers PEIA for state employees and teachers, and PEIA members use the UnitedHealthcare network
Path: behavioral credentialing starts inside Provider Express under Join Our Network. The medical application is the wrong door and costs about a month

Separate door: Optum Behavioral Health

Aetna

Behavioral health in-house, on its own form

Usually: a request for participation, an answer on network need in about 45 days, then CAQH-sourced credentialing and contracting
Path: behavioral clinicians use Aetna’s separate behavioral request for participation, not the medical one
Why the name matters twice: Aetna Better Health of West Virginia is a separate Medicaid contract, and it also carries Mountain Health Promise. If you see foster care kids, this is the name to get right

Cigna Healthcare

Behavioral health goes through Evernorth

Timing is beside the point until intake reopens: Evernorth paused new individual and clinic behavioral health applications nationally on June 1, 2026 and signaled a reopen after September 1
Exceptions: facilities are exempt, and applications filed before the pause keep moving
What we do: sequence Evernorth behind the payers that are open now and file the day intake reopens. Don’t count Cigna in a first wave this year

Separate door: Evernorth Behavioral Health

CareSource West Virginia

Marketplace only in this state

Usually: about 60 to 120 days, run as two steps: contracting first with the Health Partner Contract Form, then credentialing
Worth it when: your patient mix leans exchange coverage. CareSource sells marketplace plans here alongside Highmark
Watch: marketplace footprints move plan year to plan year, so we confirm the current counties before you build a schedule around it

Humana exited employer-group commercial medical, so in West Virginia treat Humana as a Medicare Advantage conversation rather than a commercial group contract. Peak Health is a young provider-led insurer headquartered in Morgantown and owned by WVU Medicine, Marshall Health Network and Valley Health, selling Medicare Advantage and employer options; a plan that new changes footprint faster than the nationals, so we confirm its lines of business directly. Medicare and West Virginia Medicaid work, including the Mountain Health Trust plans, are scoped separately from a commercial package.

Carry a plan we didn’t list? Add it.

PEIA is the one most people underestimate. The Public Employees Insurance Agency covers state employees, teachers and many county and municipal workers, which is a large share of insured West Virginians. It’s self-insured, and UMR, a UnitedHealthcare company, is the third-party administrator handling claims, case management, utilization management, precertification and customer service for the PPB plans. PEIA says members reach care through UnitedHealthcare’s national network, so your UnitedHealthcare and Optum work is the likely route. But PEIA runs its own benefit rules and prior approval process and sits outside state insurance law as a self-insured public plan, so we confirm the current path with PEIA and UMR rather than assuming your commercial contract already covers it.

The UMWA Health and Retirement Funds are a fixture in southern West Virginia. Union and Taft-Hartley funds are usually reached through a rented commercial network or the fund’s administrator rather than a direct contract with the fund, and much of the UMWA population is Medicare-age with the Funds wrapping around Medicare. Give us the plan name and we find the real route. You don’t need to learn the plumbing.

What we need from you

Send these once and we can start.

You give us this in one intake. Then we fill out the applications. No passwords, no patient information, and nothing gets submitted until you’ve read it and signed.

Your individual NPIPlus the Type 2 if you bill under a group or entity. West Virginia Medicaid won’t enroll or pay without it.
Active West Virginia license and DEAWV Medicaid also asks you to disclose any license or accreditation revoked or suspended in any state.
CAQH attested and authorizedEach payer authorized, or global authorization on. Highmark calls CAQH its exclusive credentialing system, so one stale attestation stalls every application at once.
Delegated PEAP accessSo we can complete your Medicaid enrollment and each plan application without password sharing. Note that Medicaid submissions go electronic-only from July 1, 2026, so the paper fallback is closing.
Malpractice certificateCurrent, naming you, with limits and dates readable.
Ownership and disclosure informationOwnership and control, business transactions, criminal conviction disclosures. Required at enrollment and again at revalidation, and an incomplete disclosure is a slow, quiet way to fail screening.
Five years of work historyNo unexplained gaps, plus board certification and education. This is the most common reason a West Virginia file sits, and the four-month clock only starts on a completed application.
Entity name, EIN and W-9One per tax ID, plus the service and correspondence addresses you want in payer directories and on file with the fiscal agent.

West Virginia licenses behavioral health centers at the organization level, separate from your own clinical license, through the Office of Health Facility Licensure and Certification. In practice it shows up around program-style operations: residential and group settings, substance use treatment, day programs, crisis services, and models that lean on staff who aren’t independently licensed. Plenty of outpatient prescribing practices never touch it. Where the line falls depends on your service mix, your staffing model and how you bill, so we ask about it at intake and flag it early. We don’t tell you whether you need a license, we don’t publish the requirements, and we don’t file it for you. That belongs with you and your own counsel.

How it works

You answer once. We do the paperwork.

You can buy online without booking a meeting. Nobody has to sell you anything first.

Buy the package

Published price and scope. No call needed.

One intake

Short and guided. It asks more only where your answers call for it.

We prepare everything

Your PEAP enrollment, each Mountain Health Trust application and every commercial application, filled out from what you told us.

You review and sign

Read it, change anything, sign. Nothing goes out until you say so.

We submit and track

You see what’s done, what’s waiting on a payer, and when you can bill.

What we commit to

Tracking is included. Every package comes with Command Suite access, so you can see where each payer application stands, what we are working on, what is waiting on a payer, and what we still need from you. You are not left guessing between the purchase and the finish.

If something we delivered does not work the way we said it would, we fix it at no charge for 30 days after delivery, including one stabilization review. That covers our own work. A new request, another payer or provider, or a change of scope is quoted separately.

Built to keep working after we are done. Everything we set up is built for the practice you are growing into, not only the one you have today. When the engagement ends you own the accounts, the documentation, and the systems, and they keep running without us.

Questions we get

West Virginia credentialing questions

How fast is Medicaid enrollment in West Virginia now?

House Bill 4335 requires the department or its agent to complete enrollment determinations within five business days of a completed application from July 1, 2026, with electronic notice inside two business days when documentation is missing. On the plan side it’s 60 calendar days on a clean application, one 30-day extension only on written justification, and the penalties reach credentialing by default. It’s brand new law, so we confirm rather than assume, and the clock only starts on a genuinely completed application.

Can I see patients while a carrier credentials me?

Law and payer policy pull different directions here, and you need both halves. W. Va. Code 33-45-2(a)(11) gives an insurer four months to accept or reject a completed application, extendable three more only for primary source verification delays, and says a provider who provides services during the credentialing period shall be paid, subject to refund if credentialing ultimately fails. Highmark, meanwhile, tells providers not to treat members before credentialing finishes. So it’s a payment right rather than a green light, and reading only the statute is how someone takes a risk their carrier warned against.

Is UniCare still a plan here?

No. UniCare Health Plan of West Virginia became Wellpoint on January 1, 2025, a full year after the same rebrand landed in other states. Agreements, contracts, reimbursement and member ID numbers didn’t change. The state lists it as Wellpoint of West Virginia. Older cards and rosters still say UniCare, and so does some body copy on Wellpoint’s own West Virginia join-our-network page, which is why the confusion persists. Here, correcting UniCare to Wellpoint is right. In some other states correcting a plan name to Wellpoint would be wrong, which is why we check per state instead of reasoning from the rebrand.

I never bill Medicaid. Do I still have to enroll?

If you write prescriptions for Medicaid members, yes. The state requires prescribers to be enrolled and requires their name and NPI on the pharmacy claim. Pharmacy is fee-for-service in West Virginia, so it reaches you through the state even when your patient is in a managed care plan. The ORP-only route exists for exactly this, and the state has said a completed ORP-only application can be enrolled in about five days, so we file it early.

Why is my Highmark clock different from my colleague’s?

Because of where your office sits. Highmark West Virginia’s network access plan says initial credentialing happens within 120 days of a completed application, citing the West Virginia statute, but 90 days if your primary practice site is in Ohio, because Ohio’s healthcare simplification law reaches it. For a Northern Panhandle practice a few miles from the border, the river changes your credentialing clock by a month.

Which behavioral health vendor handles West Virginia Medicaid?

There isn’t one for a regular Mountain Health Trust member. The plan that administers medical and dental administers behavioral health too, which is a genuine simplification against most states. The carve-out here is by population instead: Mountain Health Promise, effective March 1, 2021, moved children and youth in foster, kinship and adoptive care, plus the CSED waiver, to one statewide plan run by Aetna Better Health of West Virginia.

What about PEIA? Half my patients are teachers.

PEIA is self-insured, and UMR, a UnitedHealthcare company, is its third-party administrator for the PPB plans. PEIA says members reach care through UnitedHealthcare’s national network, so your UnitedHealthcare and Optum work is the likely route. But PEIA runs its own benefit rules and prior approval process, and as a self-insured public plan it sits outside state insurance law, including that four-month credentialing clock. We confirm the current path with PEIA and UMR instead of assuming.

Do you need my CAQH password?

No, and we won’t ask. We’re added as an authorized practice manager, which lets us keep your practice data current and authorize payers. You complete and attest your own profile and you sign your own paper applications. In West Virginia this matters more than usual, because CAQH does statewide work here and one lapsed attestation stalls everything at once.

Keep reading

West Virginia PMHNP scope of practiceWhat the state allows you to do, which is a separate question from who pays you.
Ohio payer enrollmentOne PNM application credentials you for every Medicaid plan, and carriers face a 90-day clock.
Pennsylvania payer enrollmentBehavioral health is carved out county by county, and there’s no statutory clock at all.
Virginia payer enrollmentA 60-day decision, a deemed-complete rule, and payment at the in-network rate for the wait.
Opening your own practiceEntity, identifiers, payers, EHR and billing setup.
Adding a provider to your clinicFirst-time credentialing into contracts you already hold.
Changing your entity or tax IDMoving panels without breaking the money.
All 51 state guidesEvery state’s Medicaid path, plan roster and credentialing rules.

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Where this comes from

West Virginia Legislature, Enrolled Committee Substitute for House Bill 4335, 2026 Regular Session, passed February 20, 2026: five-business-day enrollment determinations, 60-day MCO credentialing, credentialing by default, CAQH form prescribed, electronic-only submission from July 1, 2026 verified July 26, 2026
West Virginia Code 33-45-2(a)(11): four-month credential check, published list of required application contents, payment for services delivered during the credentialing period, and prompt-pay standards verified July 26, 2026
West Virginia Code, Article 1A uniform credentialing: every section now displays as repealed, with House Bill 4335 as the most recent signed bill verified July 26, 2026
WV Bureau for Medical Services, Mountain Health Trust: the four managed care plans, roughly 87 percent of Medicaid membership, and the carved-out services verified July 26, 2026
WV Bureau for Medical Services, prescriber enrollment mandate and the ORP-only route enrolled in about five days verified July 26, 2026
WV Bureau for Medical Services, Provider Manual Chapter 300: PEAP, the Provider Agreement, revalidation at least every five years, and screening categories verified July 26, 2026
WV Bureau for Medical Services, Mountain Health Promise 1915(b) waiver effective March 1, 2021 with Aetna Better Health as the single statewide plan verified July 26, 2026
WV Offices of the Insurance Commissioner, CAQH as the state’s one-stop credentialing route verified July 26, 2026
Highmark West Virginia network access plan: CAQH as the exclusive credentialing system, 120 days initial credentialing, 90 days where the primary practice site is in Ohio, three-year recredentialing verified July 26, 2026
Highmark Provider Resource Center: CertifyOS credentialing platform for West Virginia, Pennsylvania and New York from November 3, 2025 verified July 26, 2026
Wellpoint provider news: UniCare Health Plan of West Virginia became Wellpoint beginning January 1, 2025, with no change to agreements or reimbursement verified July 26, 2026
The Health Plan, join-the-network request form and the separate portal Credentialing Request Form for contracted groups verified July 26, 2026
Optum Provider Express, the behavioral door for UnitedHealthcare members verified July 26, 2026
Evernorth Behavioral Health, credentialing process and the June 1, 2026 national application pause verified July 26, 2026
WV Public Employees Insurance Agency, UMR as third-party administrator for the PPB plans and use of the UnitedHealthcare national network verified July 26, 2026
OHFLAC, behavioral health center licensure under W. Va. Code R. 64-11 and W. Va. Code 27-9-1 verified July 26, 2026

Written by Ryan Berg, founder of AdvanceAPractice. 16 years in healthcare revenue cycle and credentialing.

Facts on this page were verified July 26, 2026 and are next due for review October 26, 2026.

Payer programs, plans and timelines change. Everything here carries a verification date and gets re-checked on a review cycle; this record is next due for review on October 26, 2026. Approval and effective dates are controlled by each payer and by the state, and credentialing commonly runs 60 to 120 days per payer. This page covers payer operations. It isn’t legal, tax or scope of practice advice.