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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 15 Chapter 13 Determining Disability, Incapacity, and Blindness

OBTAINING MEDICAL REPORTS This section outlines procedural instructions for obtaining medical reports. 13.7.1 INITIAL MEDICAL REPORTS 13.7.1.A General Information About Providers The instructions that follow apply to all requests for which the provider of the service bills the Department of Human Services (DOHS). 13.7.1.A.1 Providers Certified by DOHS Requests for medical procedures and information must be made only to medical providers who have been certified for participation in DOHS’s Medicaid program. 13.7.1.A.2 Out-of-State Providers Certified by DOHS Only providers certified by the Bureau for Medical Services (BMS) are to be used to obtain initial medical reports. When necessary, the Worker must contact BMS to verify certification. 13.7.1.A.3 General Information for Completion of Medical Request Forms The following forms are for requesting information when the provider will be billing the Department. Each contains instructions to the provider to attach the form to his billing. • DFA-RT-5: General Medical Examination Report, Adults NOTE: Even when the examining physician suggests an exam or report, the case must be submitted to the Medical Review Team (MRT) for authorization by an additional medical request. Diagnostic testing must also be requested by the MRT prior to authorization.

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Page 1168

Official source

West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 15 Chapter 13 Determining Disability, Incapacity, and Blindness

OBTAINING MEDICAL REPORTS This section outlines procedural instructions for obtaining medical reports. 13.7.1 INITIAL MEDICAL REPORTS 13.7.1.A General Information About Providers The instructions that follow apply to all requests for which the provider of the service bills the Department of Human Services (DOHS). 13.7.1.A.1 Providers Certified by DOHS Requests for medical procedures and information must be made only to medical providers who have been certified for participation in DOHS’s Medicaid program. 13.7.1.A.2 Out-of-State Providers Certified by DOHS Only providers certified by the Bureau for Medical Services (BMS) are to be used to obtain initial medical reports. When necessary, the Worker must contact BMS to verify certification. 13.7.1.A.3 General Information for Completion of Medical Request Forms The following forms are for requesting information when the provider will be billing the Department. Each contains instructions to the provider to attach the form to his billing. • DFA-RT-5: General Medical Examination Report, Adults NOTE: Even when the examining physician suggests an exam or report, the case must be submitted to the Medical Review Team (MRT) for authorization by an additional medical request. Diagnostic testing must also be requested by the MRT prior to authorization.