Medical Billing in West Virginia
Soft Home Global provides billing, AR follow-up and denial appeals for West Virginia practices and billing companies at $1,600 per seat per month. Full time, worked during West Virginia business hours, inside your own system.
What is specific to West Virginia
Much of West Virginia's claim volume sits with public payers: Medicaid through the Mountain Health Trust managed care plans, a high Medicare and disability share, and PEIA for public employees.
West Virginia’s Medicaid programme is West Virginia Medicaid. Practices with a meaningful West Virginia Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a medical billing seat does in West Virginia
Aged accounts receivable called until they close, and denials read, appealed and tracked.
In West Virginia the queue that costs the most is West Virginia Medicaid, because its filing window and appeal route are not the commercial ones.
- Worklist worked from the difficult end, not the easy end
- Every call logged with the payer reference and the outcome
- Denials categorised so the same reason stops recurring
- Appeals written and submitted, not just re-bills
- Weekly written summary of what moved and what did not
- Worked during West Virginia business hours, not queued overnight
Most of the West Virginia work we see comes out of Charleston, Huntington and Morgantown, though nothing about a seat depends on where your office is — the queue is worked through your system, not from your building.
West Virginia borders 5 states, and practices near those lines almost always carry at least one out-of-state Medicaid enrollment. That is a separate portal, a separate filing window and a separate appeal route from West Virginia Medicaid, and it is the queue that most often goes unworked because it belongs to nobody.
What West Virginia law gives you
30 days for electronic clean claims; 40 days for manually submitted clean claims
West Virginia Medicaid, in practice
Mostly managed care under Mountain Health Trust with four MCOs — "Aetna Better Health of West Virginia", "The Health Plan of West Virginia", "Highmark Health Options of West Virginia" and "Wellpoint of West Virginia" — a program that "provides managed care services to approximately 87% of the state's Medicaid membership"; children on the Children with Serious Emotional Disorder Waiver "are automatically enrolled with Aetna Better Health of West Virginia" via Mountain Health Promise. Source
A large slice of West Virginia's commercial-type volume is PEIA (the state Public Employees Insurance Agency), a state agency that publishes its own fee schedules ("PEIA Fee Schedules and Manuals", including a "PEIA RBRVS") and has its own provider-add path administered by UMR rather than a carrier's normal credentialing: "New service providers in West Virginia should complete the Provider Demographic Worksheet and submit it with a copy of the W-9 form and the practitioner's license" (sent to westvirginiapeia@umr.com). Source
On the commercial side the dominant Blue plan here trades as Highmark Blue Cross Blue Shield West Virginia (legal entity: Highmark West Virginia Inc.), which matters mainly because its portal and its appeal route are the ones your seat will spend the most time in. Source
We have not been able to source West Virginia’s own Medicaid filing limit from the regulation itself, so this page does not quote one — the federal floor is twelve months from the date of service and a state may set a shorter window. Ask your West Virginia Medicaid representative for the figure in writing before you rely on it. The states we could source are listed here.
Working West Virginia hours
West Virginia runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on West Virginia hours and nobody else’s.
What it costs in West Virginia
$1,600
Per seat, per month, in US dollars — $19,200 a year for one full-time person, forty hours a week, on West Virginia hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in West Virginia run $1,400 to $2,350; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in West Virginia
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with West Virginia practices?
Yes. West Virginia accounts are worked during West Virginia office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about West Virginia?
Much of West Virginia's claim volume sits with public payers: Medicaid through the Mountain Health Trust managed care plans, a high Medicare and disability share, and PEIA for public employees.
When does a West Virginia payer have to pay a clean claim?
30 days for electronic clean claims; 40 days for manually submitted clean claims A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does medical billing cost in West Virginia?
$1,600 per seat per month — $19,200 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our West Virginia queue?
West Virginia is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle West Virginia Medicaid as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. West Virginia Medicaid has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
Next step
One seat on your West Virginia work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com