W. Va. Code R. § 64-69-7 - Application and Process

7.1. The provider shall apply for and receive reimbursement from the fund on behalf of the patient. The provider shall:

7.1.a. Refer to the list of covered procedures set forth in Section 5 of this rule, and may, if needed, consult with the director of the breast and cervical cancer screening program to determine if the procedure to be performed is covered;

7.1.b. Complete the fund application form approved by and available from the division and submit it to the director of the breast and cervical cancer screening program for approval, except as specified in subsection 7.2 of this rule;

7.1.c. Provide the services; and

7.1.d. Submit an invoice to the director of the breast and cervical cancer screening program listing procedures and CPT codes, accompanied by a pathology report when appropriate, within ninety (90) days of the date the service was provided.

7.2. The provider shall complete only the medical eligibility section of the application for patients who have already been screened and determined to meet the financial eligibility criteria through the breast and cervical cancer screening program.

7.3. The division shall use the current rate established by Medicare to determine the amount of payment.

7.4. Providers performing procedures to be covered by the fund shall accept the Medicare-determined payment amount as full payment.

Notes

W. Va. Code R. § 64-69-7