Reliable Revenue Cycle Management in West Virginia
Mediknocx manages the revenue cycle for West Virginia practices, from the first eligibility check to the final zero balance. We build your workflow around the payers you actually bill: Highmark Blue Cross Blue Shield West Virginia (the largest commercial carrier, with roughly 250,000 members), four Medicaid managed care plans, and PEIA.
HIPAA Compliant
Your data stays secure
Faster Payments & Fewer Denials
Improve cash flow
Higher Reimbursement
Get the revenue you deserve
West Virginia Billing Compliance Experts
State-specific payer knowledge
Get Your Free Revenue Assessment
Find out how much revenue your practice could be recovering with expert revenue cycle management support. No obligation, just real insights.
Reliable Revenue Cycle Management in West Virginia: Four Medicaid MCOs and a PEIA Payment-in-Full Rule
West Virginia Medicaid runs mostly through Mountain Health Trust, where the Bureau for Medical Services contracts with four MCOs: Aetna Better Health of West Virginia, Highmark Health Options of West Virginia, The Health Plan, and Wellpoint West Virginia. They served about 485,956 members in 2025, and each sets its own authorization lists and appeal steps. Fee-for-service claims must reach BMS within 12 months of the date of service.
PEIA adds a second layer. Claims for its Preferred Provider Benefit plans are processed by UMR, HMO members go through The Health Plan, and Medicare-primary retirees move to Humana. Under W. Va. Code §16-29D-4, a provider treating a PEIA member accepts the plan's allowed amount as payment in full. Miss a required prior approval and the patient can owe the full cost, a balance few practices ever collect.
Expertise
Built for local care models
Deadline Tracking
We flag at-risk claims early
Fewer Denials
Correct coding, less revenue loss
The Full Revenue Cycle We Manage in West Virginia
- Patient Access & Eligibility Verification: Active coverage, the correct MCO or PEIA plan, and prior approval needs are confirmed before the visit.
- Charge Capture & Coding: Certified coders check CPT, ICD-10, and modifiers against documentation.
- Claims Submission: Electronic claims go to Highmark BCBS West Virginia, Palmetto GBA, UMR, and each Medicaid plan.
- Payment Posting: ERAs and EOBs are posted and matched to contracted rates.
- Denial Management & Appeals: Each denial gets a root cause and an appeal inside the payer's window.
- AR Follow-Up: Open claims are worked by age and payer before deadlines pass.
- Reporting: Monthly reports on collections, denials, and days in AR.
How It Works
From Audit toFaster Payments in 4 Steps
A simple, proven process to streamline your revenue cycle and maximize reimbursements in West Virginia.
Free Audit
We review recent claims, denials, and aging AR to find revenue leaks.
Custom Plan
A written plan covers payer setup, workflow fixes, and reporting.
Seamless Transition
We connect to your practice management system without pausing claims.
Ongoing Reporting
Monthly reports and a review call keep you current.
Ready to See Where Your West Virginia Revenue Is Going?
Call +1 434-201-9720 or email info@mediknocx.com to book a free revenue cycle audit.
What Makes Our West Virginia
Revenue Cycle Management Different
We treat the revenue cycle as one connected process, so a problem at the front desk never becomes a surprise in your AR report.
Full-Cycle Ownership
One team handles eligibility, coding, claims, posting, denials, and follow-up. Nothing falls between vendors, and you always know who owns a stalled claim, a short payment, or a rejected appeal.
West Virginia Payer Knowledge
We work Highmark BCBS West Virginia, PEIA through UMR, Palmetto GBA for Medicare, and all four Mountain Health Trust plans, each with its own authorization rules and claim edits.
Timely-Filing Tracking
Every open claim carries its payer deadline, from Medicaid's 12-month limit to shorter commercial windows. Claims nearing a cutoff get worked first so revenue isn't written off for late submission.
Denial Root-Cause Work
We don't just resubmit. Each denial is traced to its source, whether eligibility, coding, or authorization, and the fix is applied upstream so the same error stops coming back.
Monthly Reporting Cadence
Each month you receive clear reports on collections, denial trends, payer mix, and days in AR, followed by a review call where we explain what changed and what we're doing next.
Compliance-Minded Workflows
HIPAA safeguards, payer contract terms, and West Virginia prompt pay rules shape how we submit, follow up, and appeal. Our processes are documented and reviewed so your practice stays audit-ready.
Specialty Expertise That Works for You
Mediknocx supports revenue cycle work across all 47 specialties, including cardiology, orthopedics, OB-GYN, behavioral health, pain management, and family practice. A cardiology group billing Highmark faces different authorization edits than a behavioral health practice billing a Medicaid MCO, so coders are assigned by specialty.
How Does Mediknocx Ensure Compliance
With West Virginia Medical Billing Regulations?
No Surprises Act
We help practices issue good faith estimates to uninsured and self-pay patients and follow federal limits on out-of-network balance billing.
West Virginia Timely Filing and Prompt Pay
W. Va. Code §33-45-2 requires insurers to pay or deny a clean claim within 30 days if filed electronically and 40 days on paper. We track your filing deadlines and each payer's payment deadline.
West Virginia Billing Transparency and Itemization
W. Va. Code §16B-3-9 requires licensed hospitals to provide one free itemized statement on request. We prepare line-item patient statements for practices too, so billing questions get answered quickly.
Payer-Specific Guidelines
We follow the published policies of Highmark BCBS West Virginia, UMR for PEIA's PPB plans, Palmetto GBA (Jurisdiction M) for Medicare Part B, and each Mountain Health Trust MCO.
Healthcare Billing Services Across West Virginia Cities
Mediknocx supports practices throughout West Virginia, including Charleston, Huntington, and Morgantown.
- Charleston
- Huntington
- Morgantown
- Parkersburg
- Wheeling
Nationwide Revenue Cycle Management
Beyond West Virginia, Mediknocx supports practices in Georgia, Florida, Illinois, Indiana, Missouri, New Mexico, Delaware, Wyoming, Idaho, and Hawaii.
Let's Fix Your Revenue Cycle, Starting This Month
Talk with a revenue cycle specialist about your West Virginia payer mix. Call +1 434-201-9720 or write to info@mediknocx.com.
Frequently Asked Questions
Find answers to the most common questions about our revenue cycle management services in West Virginia.
