Medical billing services in West Virginia
SwiftCare Billing provides medical billing services in West Virginia for practices that bill West Virginia Medicaid, Palmetto GBA (Medicare), and carriers like Highmark Blue Cross Blue Shield of West Virginia. Pricing starts at 3% of collections. Month-to-month, 30 days’ notice.
- 98.4% Clean Claim Rate
- 175+ Providers
- 50+ Specialties
- 12+ Years
West Virginia billing rules at a glance
| Item | West Virginia |
|---|---|
| Medicaid program | West Virginia Medicaid, run by the Bureau for Medical Services (BMS) |
| Medicaid enrollment | About 488,000 in July 2026: 382,470 in Mountain Health Trust plans, 23,512 in Mountain Health Promise, 81,786 fee-for-service |
| Health plans | Aetna Better Health of West Virginia, The Health Plan, Wellpoint, Highmark Health Options |
| Foster, kinship and adoptive care | Mountain Health Promise, run by Aetna Better Health of West Virginia |
| Medicare A/B contractor | Palmetto GBA, Jurisdiction M (also NC, SC, VA) |
| Medicare DME contractor | DME MAC Jurisdiction C |
| Medicare timely filing | 12 months from date of service |
| Medicaid timely filing | Fee-for-service: BMS manual, Chapter 800.11; Aetna Better Health allows 365 days |
| Commercial prompt pay | 30 days electronic, 40 days manual; 10% annual interest after day 40 (W. Va. Code 33-45-2) |
| Surprise billing | Federal No Surprises Act |
| Workers’ compensation | State schedule: West Virginia Medicare rate plus 35%; some carriers set their own |
What's changing for West Virginia providers
Four plans, and some new names
Wellpoint took over from UniCare, and Highmark Health Options started taking members on August 1, 2024. By July 2026, Highmark had about 18,400 members and was growing every month. Patients may still carry old cards. A claim to the wrong plan is a denial. We check the plan on the date of service.
Work requirements start January 1, 2027
Adults 19 to 64 in the expansion group will need 80 hours of work or approved activity per month, according to BMS. State estimates say about 33,700 of 161,000 expansion members must take action. Current members aren’t affected until their 2027 renewal, and the earliest renewals start in March. We re-verify eligibility at each visit.
Corrected claims run on a short clock
Aetna Better Health of West Virginia accepts first claims for 365 days. But corrected claims and disputes have to arrive within 120 days of the remittance date. Practices that wait lose appeals they should have won. We resubmit corrections the week they appear.
Medical billing services in West Virginia: how a claim gets paid
You can hand us everything or one piece. Here’s where each step sits.
3. Submit
Claim submission and tracking
Claims scrubbed, then tracked against the 30-day electronic clock
5. Collect
Accounts receivable follow-up
Oldest claims first
Physician billing services in West Virginia
Our physician billing services suit solo doctors and multi-provider groups. AAPC-certified coders assign CPT, ICD-10, and HCPCS codes and apply each payer’s modifier rules.
Hospital medical billing solutions in West Virginia
For hospital-based physician groups and outpatient departments, we handle professional claims and denials across the same plans.
Medical practice billing support in West Virginia
Many practices here run billing with one or two people. We act as your back office, so a sick day or a resignation doesn’t stop claims. You get one named account manager.
Healthcare reimbursement services in West Virginia
Getting paid isn’t the same as getting paid correctly. We compare payments against contracted rates and flag underpayments. For work injuries, we check each payment against the state schedule, which is the West Virginia Medicare rate plus 35%.
Medical accounts receivable management in West Virginia
We work open claims by age and payer. Commercial claims that run past day 40 accrue 10% annual interest under state law, so we chase them and claim what’s owed.
Getting credentialed and enrolled in West Virginia
A provider who isn’t enrolled doesn’t get paid. West Virginia Medicaid enrollment comes first, then a contract with each health plan you want to join. Our medical credentialing services handle every layer.
- NPI check and an attested CAQH profile
- Medicare enrollment through PECOS, processed by Palmetto GBA
- West Virginia Medicaid provider enrollment through BMS
- Credentialing with each Mountain Health Trust plan you choose
- Commercial plan applications
- Revalidation reminders
West Virginia payers we work with
- Medicare: Palmetto GBA (Part A and B), DME MAC Jurisdiction C, and Medicare Advantage plans
- Mountain Health Trust: Aetna Better Health of West Virginia, The Health Plan, Wellpoint, Highmark Health Options
- Commercial: Highmark Blue Cross Blue Shield West Virginia, Aetna, Cigna, UnitedHealthcare
- Workers' compensation carriers
Specialties we support in West Virginia
We bill 50+ specialties. West Virginia practices often come to us in family practice, pediatrics, mental health, physical therapy, chiropractic, and cardiology.
Works with the EHR you already use
We support 80+ systems, including Epic, athenahealth, eClinicalWorks, Tebra (Kareo), and AdvancedMD. We also connect to your clearinghouse and the state Medicaid portal.
Practices we serve across West Virginia
Charleston, Huntington, Morgantown, Parkersburg, Wheeling, Martinsburg, Beckley, Clarksburg, Fairmont, and Bridgeport, plus the Eastern Panhandle and rural counties in between. SwiftCare Billing serves providers in all 50 states.
Why choose SwiftCare Billing in West Virginia
- A team, not one biller. 200+ certified billers work on our clients' claims.
- Certified coders. AAPC-certified coders review the codes.
- U.S.-based staff. Your claims and patient data stay with a team in the United States.
- One person to call. Every practice gets a named account manager.
- Monthly reporting. You see collections, denials and A/R every month.
- Paperwork first. We sign a business associate agreement before we open a single record, and we report any breach as the agreement requires.
- Your data stays yours. If you leave, your claims and patient accounts go with you.
- Rule changes, flagged early. We track West Virginia updates, like plan changes and the 2027 work requirements, and tell you before they reach your claims.
What it costs and how we start
Most practices pay between 3% and 8% of collections, depending on specialty, claim volume, and payer mix. A free audit gives you a quote from your own claims.
- Send recent claims; we return a written audit in 5 business days.
- Give us access to your EHR and clearinghouse.
- We check your enrollment with Palmetto GBA, BMS, and each plan.
- We review fee schedules and payer contracts.
- You go live in 7 to 14 business days, with monthly reports after that.
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FAQs
How much do medical billing services cost in West Virginia?
Fees depend on specialty, volume, and payer mix. A practice with mostly Medicaid claims prices differently from one with mostly commercial. The audit uses your actual claims, so you get a real number.
Which West Virginia Medicaid plans do you bill?
All four Mountain Health Trust plans: Aetna Better Health of West Virginia, The Health Plan, Wellpoint, and Highmark Health Options. We also bill Mountain Health Promise and handle credentialing with each plan.
Who processes Medicare claims in West Virginia?
Palmetto GBA, as the A/B MAC for Jurisdiction M. DME claims go to DME MAC Jurisdiction C. Medicare claims must be filed within 12 months of the service date.
How fast must West Virginia insurers pay a claim?
Insurers must pay or deny a clean claim within 30 days if electronic and 40 days if submitted manually. After day 40, interest accrues at 10% a year. Self-funded employer plans follow federal law instead.
How does workers' comp billing work in West Virginia?
The state’s maximum is the West Virginia Medicare rate plus 35%. Approved managed health care plans, self-insured employers, and some private carriers can set their own fees. We confirm which applies before billing.
Will Medicaid work requirements affect my billing?
Probably, starting in 2027. Some expansion adults will lose coverage if they don’t meet the 80-hour rule. We check eligibility before each visit, so you know before a patient is seen.
Can you work inside our EHR and handle credentialing?
Yes to both. We handle enrollment with BMS, each plan, and commercial carriers, and we work inside more than 80 systems. You keep your EHR.
How soon can you take over our billing?
Go-live takes 7 to 14 business days once we have access to your systems.
Bring us your last 90 days of Mountain Health Trust claims
Tell us which Medicaid plans and commercial payers you bill. We’ll review your recent claims and send a written report within 5 business days.