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West Virginia Children's Health Insurance Program (WVCHIP) Prescription Claims Update!
Beginning July 1, 2024, WVCHIP Pharmacy's Point-of-Sale claims will be processed by West Virginia Medicaid's claims processor, Gainwell Technologies. The WVCHIP pharmacy claims with dates of services beginning now through June 30, 2024, will continue to be processed by Express Scripts, the WVCHIP's current Pharmacy Benefit Manager. Please use West Virginia Medicaid's Bank Identification Number (BIN) 610164 and the Processor Control Number (PCN): DRWVPROD, for WVCHIP prescription drug claims with dates of services of July 1, 2024 and after. NOTE: The WVCHIP members will receive new member cards, prior to July 1, 2024, with updated information removing Express Scripts as the Pharmacy Benefit Manager. Member ID numbers are not changing.
For questions regarding the processing of the WVCHIP pharmacy claims as of July 1, 2024, please refer to HEALTH PAS Online - West Virginia Medicaid and WVCHIP's Provider and Member portals.
Further details specifically regarding the WVCHIP claims processing, including the BIN and PCN, is located in the current West Virginia Medicaid Vendor Specification Document D.0 on the Gainwell Technologies Pharmacy Forms webpage under the "Reference Material" tab.
West Virginia University (WVU) School of Pharmacy's Rational Drug Therapy Program (RDTP) will continue to manage prior authorizations and edit overrides for WVCHIP. You may contact the RDTP by calling 1-800-847-3859, and by fax at 1-800-531-7787. If you have any general questions regarding this update, please contact Gainwell Technologies' West Virginia Medicaid and WVCHIP's Pharmacy Provider Help Desk at 1-888-483-0801. The help desk number for members is 1-888-483-0797.
