How to become a Medicaid provider in West Virginia
To bill West Virginia Medicaid, enroll through Provider Enrollment Application Portal (PEAP) on the BMS fiscal agent's site (wvmmis.com), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
- Enrollment portal
- Provider Enrollment Application Portal (PEAP) on the BMS fiscal agent's site (wvmmis.com)
- Steps
- 6
- Documents
- 5
- Plans listed
- 4
On this page
West Virginia Medicaid enrollment at a glance
To bill West Virginia Medicaid, enroll through Provider Enrollment Application Portal (PEAP) on the BMS fiscal agent's site (wvmmis.com), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
- Program
- West Virginia Medicaid (Bureau for Medical Services, BMS), including WVCHIP and Mountain Health Trust managed care
- Enrollment portal
- Provider Enrollment Application Portal (PEAP) on the BMS fiscal agent's site (wvmmis.com)
- Fiscal agent
- Gainwell Technologies
- Application fee
- Institutional providers pay the federal application fee, and two separate institutional provider types pay two fees. WV may also charge it to institutional entities that bill fee-for-service, such as personal care agencies, non-emergency transportation providers and residential treatment centers. The fee, or proof it was paid to another program, must come with the application. A hardship exception request goes in with the application; WV Medicaid reviews it and forwards it to CMS for the decision. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
- Fingerprinting
- BMS Provider Manual Chapter 300 says high-risk screening includes fingerprint-based background checks. Enrollment is denied or terminated if the provider, or a 5%+ owner, does not submit fingerprints within 30 days of a request. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.
- Site visit
- Screening for moderate- and high-risk providers includes site visits. Enrolling a new practice location, or adding one to an existing moderate- or high-risk enrollment, also requires a site visit.
- Revalidation
- As part of federal revalidation, providers confirm their enrollment information and update disclosures at set intervals. A screening by Medicare or another state's Medicaid/CHIP within the past five years can be relied on for the federal requirements. Not submitting revalidation documents ends participation. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.
- Provider manual
- Provider manual
Steps
- Get an NPI and hold a valid license or certification in the state where you practice
- File the WV Medicaid enrollment application online through PEAP on the fiscal agent's Provider Enrollment page (a paper application is also allowed)
- Include ownership and controlling-interest disclosures, and the application fee or proof of payment if you are institutional
- Complete risk-based screening; enrollment is not finished until all screening is done
- Keep a current license and W-9 on file with Gainwell
- To join a Mountain Health Trust MCO, contact the MCO directly for contracting and credentialing
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- Mountain Health Trust covers about 87% of WV Medicaid members. Each MCO must itself enroll with WV Medicaid and handles contracting and credentialing for its own network, with standards at least as strict as fee-for-service. Providers contact each MCO directly. BMS describes no centralized credentialing. Pharmacy, long-term care, HCBS waivers and NEMT are carved out of managed care.
- Plans (state list)
- Aetna Better Health of West Virginia
- The Health Plan of West Virginia
- Highmark Health Options of West Virginia
- Wellpoint of West Virginia
Frequently asked questions
How do I become a Medicaid provider in West Virginia?
To bill West Virginia Medicaid, enroll through Provider Enrollment Application Portal (PEAP) on the BMS fiscal agent's site (wvmmis.com), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in West Virginia Medicaid?
Institutional providers pay the federal application fee, and two separate institutional provider types pay two fees. WV may also charge it to institutional entities that bill fee-for-service, such as personal care agencies, non-emergency transportation providers and residential treatment centers. The fee, or proof it was paid to another program, must come with the application. A hardship exception request goes in with the application; WV Medicaid reviews it and forwards it to CMS for the decision. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
How often must West Virginia Medicaid providers revalidate?
As part of federal revalidation, providers confirm their enrollment information and update disclosures at set intervals. A screening by Medicare or another state's Medicaid/CHIP within the past five years can be relied on for the federal requirements. Not submitting revalidation documents ends participation. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.