Medical Billing Services in West Virginia
As a remote-first medical billing company serving West Virginia practices statewide, MedPrecision pairs WV-specific payer expertise with AAPC-certified billing experts. West Virginia Medicaid is a managed care program for most members, and the filing limits that bind a claim are the ones in the member's plan. Aetna Better Health of West Virginia, for example, requires a new claim on a valid claim form within 365 days of the date of service, treats the discharge date as the date of service on hospital inpatient claims, allows 365 days from the primary remittance advice for a coordination-of-benefits claim, and gives only 120 days from the original remittance advice for a reconsideration — a much shorter clock than the filing one, and the one practices miss (Aetna Better Health of West Virginia Provider Manual, retrieved 17 September 2026). On the commercial side, Highmark Blue Cross Blue Shield West Virginia is the largest carrier in the state, which makes fee-schedule accuracy and disciplined appeals non-negotiable. West Virginia Code 33-45-2(a)(1) requires an insurer to pay or deny a clean claim within 40 days of receipt when it is submitted manually and 30 days when it is submitted electronically, and that duty runs through the provider contract rather than as a free-standing rule, so prompt-pay tracking is part of every weekly A/R review we run for West Virginia accounts. We run West Virginia claim queues with payer-segmented edits, plan portal work and appeal letters drafted against the citations the state's Offices of the Insurance Commissioner actually enforces. Statute text verified at code.wvlegislature.gov on 17 September 2026.
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The West Virginia Billing Landscape
West Virginia expanded Medicaid under the ACA and enrolls a large share of its population: 486,392 people were in Medicaid or CHIP in May 2026, 447,082 in Medicaid and 39,310 in CHIP, per CMS enrollment data. The Mountain Health Trust managed care program is administered by four plans — Aetna Better Health of West Virginia, The Health Plan of West Virginia, Highmark Health Options West Virginia and Wellpoint, formerly UniCare — and a separate specialized program, Mountain Health Promise, serves children and youth in foster, kinship and adoptive care with Aetna Better Health of West Virginia as its single plan. The commercial market is led by Highmark Blue Cross Blue Shield West Virginia, followed by The Health Plan, UnitedHealthcare and Aetna. West Virginia's prompt-pay rule, Code 33-45-2, gives an insurer 40 days on a manually submitted clean claim and 30 days on an electronic one, with 10 percent annual interest after the 40-day period, and it operates as a required provider-contract term rather than a stand-alone duty. The state faces real access pressure: an older population than most states, high chronic disease prevalence, and provider shortages across much of its territory. WVU Medicine, CAMC Health System and Mon Health are the major health systems. Demand for behavioral health and substance use disorder services is high, which makes authorization management a core competency rather than a niche one. Rural and Appalachian communities depend on critical access hospitals, federally qualified health centers and telehealth, and those facilities bill on encounter-rate and cost-based methodologies rather than ordinary fee schedules. West Virginia requires commercial telehealth coverage under Code 33-57-1, with same-rate reimbursement for established patients and negotiated rates for virtual telehealth encounters. Low Medicaid reimbursement combined with high patient acuity means West Virginia practices have to collect precisely on every eligible dollar to stay viable. Program roster and statute text verified at dhhr.wv.gov and code.wvlegislature.gov on 17 September 2026.
Who We Serve in West Virginia
Our West Virginia client mix skews toward solo practices, rural health clinics, behavioral health practices , plus critical access hospitals and telehealth providers. We work with providers in Charleston, Huntington, Morgantown and across the rest of the state, all remotely.
Major Metros Served
What billing costs in West Virginia
We publish one national rate card and bill West Virginia practices on exactly the same terms as everywhere else — there is no regional markup and no quote-only tier below enterprise. You pay a percentage of what we actually collect, so if we do not collect, you do not pay.
| Practice size | Rate | Basis | Note |
|---|---|---|---|
| Solo practice | 7.0% | of monthly collections | Monthly minimum applies |
| Group practice | 6.0% | of monthly collections | Volume discounts available |
| Enterprise | Custom | tiered pricing | Scoped per engagement |
- No setup or implementation fee
- No per-claim charge
- No software fee and no markup on third-party costs — clearinghouse fees, postage and payer application fees are passed through at cost
- 12-month initial term, then month-to-month — 60 days' notice either way, no early-termination penalty
Payer Landscape in West Virginia
West Virginia Medicaid (Mountain Health Trust managed care, with Mountain Health Promise for children and youth in foster, kinship and adoptive care) routes members through Aetna Better Health of West Virginia, The Health Plan of West Virginia, Highmark Health Options West Virginia and 1 more plans, each with its own authorization rules and fee schedule. On the commercial side, Highmark Blue Cross Blue Shield West Virginia, The Health Plan, UnitedHealthcare drive the bulk of West Virginia claim volume, so we maintain payer-specific denial playbooks and appeal templates for each. Claim clocks in West Virginia run 365 days for Medicaid and 90-180 days for commercial payers — deadlines our A/R queues are built around. West Virginia's prompt-pay statute: West Virginia Code 33-45-2(a)(1) requires an insurer to pay or deny a clean claim within 40 days of receipt when the claim is submitted manually and within 30 days when it is submitted electronically, subject to exceptions for another responsible payer, coordination of benefits, a claim already paid, fraud or material misrepresentation. The insurer must request any additional information it needs within 30 days, and then pay or deny within 30 days of receiving it. Subsection (a)(4) adds interest at 10 percent per annum accruing after the 40-day period, payable without demand and with an explanation of the assessment. These are minimum fair business standards that must appear in every provider contract entered into, amended, extended or renewed on or after August 1, 2001, so the obligation runs through the contract; the Offices of the Insurance Commissioner has jurisdiction over an insurer that fails to include or implement them. Verified at code.wvlegislature.gov on 17 September 2026.
Medicaid Program
West Virginia Medicaid (Mountain Health Trust managed care, with Mountain Health Promise for children and youth in foster, kinship and adoptive care)
Managed Care Organizations
Key Commercial Payers
Timely Filing Deadlines
Prompt Pay Law
West Virginia Code 33-45-2(a)(1) requires an insurer to pay or deny a clean claim within 40 days of receipt when the claim is submitted manually and within 30 days when it is submitted electronically, subject to exceptions for another responsible payer, coordination of benefits, a claim already paid, fraud or material misrepresentation. The insurer must request any additional information it needs within 30 days, and then pay or deny within 30 days of receiving it. Subsection (a)(4) adds interest at 10 percent per annum accruing after the 40-day period, payable without demand and with an explanation of the assessment. These are minimum fair business standards that must appear in every provider contract entered into, amended, extended or renewed on or after August 1, 2001, so the obligation runs through the contract; the Offices of the Insurance Commissioner has jurisdiction over an insurer that fails to include or implement them. Verified at code.wvlegislature.gov on 17 September 2026.
West Virginia Billing Regulations & Compliance
The West Virginia Offices of the Insurance Commissioner sets the rules our West Virginia billing workflows have to satisfy. Surprise billing in West Virginia: The federal No Surprises Act applies to emergency services, to non-emergency services delivered by out-of-network providers at in-network facilities, and to air ambulance services. Complaints about a West Virginia-regulated plan go to the West Virginia Offices of the Insurance Commissioner; complaints about a self-funded plan go to the federal No Surprises Act help desk. Telehealth parity: West Virginia Code 33-57-1, enacted as HB 4003 (2020) and amended in 2021, requires insurers regulated under chapters 33-15, 33-16, 33-24, 33-25 and 33-25A to cover a telehealth service they cover in person for policies issued or renewed on or after July 1, 2020, and bars excluding a service from coverage solely because it was delivered by telehealth. For plans issued, renewed, amended or adjusted on or after July 1, 2021, an established patient's telehealth encounter, and consulting care to a patient in an acute care facility, is reimbursed at the same rate as in person; a virtual telehealth encounter — a new or follow-up patient for acute care not requiring chronic management or scheduled medications — is paid at a negotiated rate. Telehealth services include audio-only calls but not email or fax, an originating site may charge a site fee, and no telehealth-specific dollar maximum or extra cost sharing may be imposed. Self-funded employer plans are outside these chapters. Verified at code.wvlegislature.gov on 17 September 2026.
State Insurance Regulator
West Virginia Offices of the Insurance Commissioner
Surprise Billing Protection
The federal No Surprises Act applies to emergency services, to non-emergency services delivered by out-of-network providers at in-network facilities, and to air ambulance services. Complaints about a West Virginia-regulated plan go to the West Virginia Offices of the Insurance Commissioner; complaints about a self-funded plan go to the federal No Surprises Act help desk.
Telehealth Billing Parity
West Virginia Code 33-57-1, enacted as HB 4003 (2020) and amended in 2021, requires insurers regulated under chapters 33-15, 33-16, 33-24, 33-25 and 33-25A to cover a telehealth service they cover in person for policies issued or renewed on or after July 1, 2020, and bars excluding a service from coverage solely because it was delivered by telehealth. For plans issued, renewed, amended or adjusted on or after July 1, 2021, an established patient's telehealth encounter, and consulting care to a patient in an acute care facility, is reimbursed at the same rate as in person; a virtual telehealth encounter — a new or follow-up patient for acute care not requiring chronic management or scheduled medications — is paid at a negotiated rate. Telehealth services include audio-only calls but not email or fax, an originating site may charge a site fee, and no telehealth-specific dollar maximum or extra cost sharing may be imposed. Self-funded employer plans are outside these chapters. Verified at code.wvlegislature.gov on 17 September 2026.
Common Questions
Common questions about medical billing services in West Virginia.
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Get a Free Billing AuditHow does MedPrecision handle West Virginia Medicaid MCO billing?
Mountain Health Trust, the state's Medicaid managed care program, now runs through four plans: Aetna Better Health of West Virginia, The Health Plan of West Virginia, Highmark Health Options West Virginia and Wellpoint, which is the plan formerly branded UniCare. Children and youth in foster, kinship and adoptive care are served by a separate specialized program, Mountain Health Promise, for which Aetna Better Health of West Virginia is the single managed care organization, and members eligible for the Children with Serious Emotional Disorder Waiver are enrolled there automatically. Each plan sets its own prior authorization workflow, fee schedule and claim clocks, and those clocks are not all the same length: Aetna Better Health of West Virginia allows 365 days from the date of service for a new claim and 365 days from the primary remittance advice for a coordination-of-benefits claim, but only 120 days from the original remittance advice for a reconsideration. We confirm which plan and which program a member is in before charge entry rather than after a denial, and we work the reconsideration window as the binding deadline it is. Plan roster verified at dhhr.wv.gov on 17 September 2026.
Can MedPrecision support rural and Appalachian health practices in West Virginia?
Yes. Rural health clinics and critical access hospitals in West Virginia are not billed like fee-schedule professional practices: RHC claims run on an encounter rate, critical access hospitals are reimbursed on a cost basis for Medicare, and the payer mix in remote counties is narrower than it is in Charleston or Morgantown. Those differences change how a claim is built, what an underpayment looks like on the remittance, and which appeal argument works. We set the claim queue up around the facility type and reimbursement methodology the practice actually bills under.
Does MedPrecision handle behavioral health and substance abuse billing in West Virginia?
Yes. Demand for behavioral health and substance use disorder services is high across West Virginia, and the billing is authorization-heavy: medication-assisted treatment, counseling sessions and intensive outpatient programs each carry their own coding, unit and authorization rules, and those rules differ between the four Mountain Health Trust plans and again for members in Mountain Health Promise. We code to the plan that will adjudicate the claim and track authorizations against the service dates they actually cover, which is where most avoidable denials in this category start.
How does MedPrecision support telehealth billing for West Virginia providers?
Telehealth is essential for reaching patients across West Virginia's rural communities, and the state's coverage rule is West Virginia Code 33-57-1. For commercial policies issued or renewed on or after July 1, 2020 an insurer must cover a telehealth service it covers in person, and it may not exclude a service from coverage solely because it was delivered by telehealth. Payment is where practices get caught out: for plans issued, renewed, amended or adjusted on or after July 1, 2021, an established patient's telehealth encounter — or consulting care to a patient in an acute care facility — is reimbursed on the same basis and at the same rate as in person, while a virtual telehealth encounter, meaning a new or follow-up patient for acute care that does not require chronic management or scheduled medications, is paid at a rate negotiated between the provider and the insurer. The statute's definition of telehealth services includes audio-only telephone calls but excludes email and fax, and an originating site may charge a site fee. We manage telehealth claims with the correct place-of-service codes and modifiers and against the category the encounter actually falls into. Verified at code.wvlegislature.gov on 17 September 2026.
What happens if a payer misses the West Virginia prompt-pay deadline?
West Virginia's prompt-pay rule for health care claims is West Virginia Code 33-45-2, in the Ethics and Fairness in Insurer Business Practices article — not 33-15-4b, which is a nursing-services coverage mandate. Subsection (a)(1) requires an insurer to pay or deny a clean claim within 40 days of receipt if it was submitted manually and within 30 days if it was submitted electronically, with exceptions where another payer is responsible, benefits are being coordinated, the provider was already paid, or the claim was fraudulent or materially misrepresented. Under (a)(3) the insurer has 30 days to request any additional information it needs, must use all reasonable efforts to ask once, and then has 30 days from receiving that information to pay or deny. Interest of 10 percent per annum accrues after the 40-day period and must be paid without demand, with an explanation of the assessment, at payment or within 30 days after. One qualification matters: these are minimum fair business standards that every provider contract entered into, amended, extended or renewed on or after August 1, 2001 must contain, so the duty reaches you through your contract, and the Commissioner has jurisdiction over an insurer that fails to include or implement them. A previously paid claim can generally only be taken back within one year, and only for the reasons listed in (a)(7). We track every clean claim against those deadlines, flag stalled payments in our A/R reports, and escalate to the West Virginia Offices of the Insurance Commissioner when a payer defaults. Medicaid filing limits are set by the member's plan — Aetna Better Health of West Virginia, for instance, runs 365 days from the date of service for a new claim and 120 days from the original remittance advice for a reconsideration — and commercial claims in West Virginia typically run 90 to 180 days. Verified at code.wvlegislature.gov on 17 September 2026.
How do I choose a medical billing company in West Virginia?
Prioritize a billing company that already works with West Virginia Medicaid and the major commercial payers in West Virginia — payer-specific edits and timely-filing windows are where most WV revenue leaks start. Ask about AAPC-certified coders, transparent pricing, and denial-rate and days-in-A/R reporting before you sign. Because billing is delivered remotely, a company's West Virginia payer experience matters more than a local office address.
Services for West Virginia practices
Specialties we bill for
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Services in West Virginia
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