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West Virginia2026Enacted

HB4335

New Rules for Medicaid Provider Enrollment and Credentialing

Last scannedAug 22, 2026, 11:08 AM

In one sentence

This law sets strict time limits for processing Medicaid provider applications, requires a single standard form for all managed care organizations, and mandates that all submissions be done electronically.

What it does

  • Requires the Department of Human Services or its agent to finish enrollment decisions within five business days of receiving a complete application by July 1, 2026.
  • Mandates that Medicaid managed care organizations must credential providers within 60 calendar days unless they get written approval for one extra month.
  • Allows penalties for insurance companies that miss these deadlines, including corrective action plans, monetary sanctions, or automatic approval of the provider's credentials at the department's discretion.
  • Establishes a single standard electronic form for all credentialing applications to remove duplicate paperwork requirements.
  • Requires all enrollment and renewal documents from providers to be submitted only through electronic means starting July 1, 2026.

Who it affects

  • Medicaid providers seeking to join or renew their status in the program
  • The Department of Human Services and its fiscal agent
  • Medicaid managed care organizations operating in West Virginia
  • The Office of the Insurance Commissioner

Limits and unknowns

  • The law does not specify exact dollar amounts for monetary sanctions; these are established in contracts.
  • The text states the agent must be accredited by the National Committee for Quality Assurance but does not name which specific company will serve as the agent.

Plain language

Terms to know

Credentialing
The process where an insurance company checks a provider's qualifications to allow them to treat patients.
Managed care organization
A private health insurance company that manages Medicaid services for the state.
Credentialing-by-default
Automatic approval of a provider's application if the insurance company fails to finish checking them on time, decided by the department.

Official record

Sources

Validated
Official bill pageIntroduced textCurrent bill textStored full record

Official summary

Relating to Medicaid providers

Official activity

Bill history

  1. Chapter 182, Acts, Regular Session, 2026H
  2. Approved by Governor 2/28/2026 - House JournalH
  3. Approved by Governor 2/28/2026H
  4. Approved by Governor 2/28/2026 - Senate JournalS
  5. To Governor 2/23/2026 - Senate JournalS
  6. To Governor 2/23/2026H
  7. House Message receivedS
  8. Completed legislative actionH
  9. Communicated to SenateH
  10. Effective from passage (Roll No. 134)H
  11. House concurred in Senate amendment and passed bill (Roll No. 133)H
  12. House received Senate messageH
  13. Senate requests House to concurS
  14. Effective from passage (Roll No. 154)S
  15. Title amendment adoptedS
  16. Passed Senate (Roll No. 153)S
  17. Read 3rd timeS
  18. On 3rd readingS
  19. Read 2nd timeS
  20. On 2nd readingS

Changes

Amendments

2 stored

hb4335 sfat helton _ 2-19 adopted.htm

This amendment changes the bill's title to list specific new rules for Medicaid providers, including faster enrollment times, standard checks for insurance companies, and a requirement to use electronic forms.

hb4335 sfat helton _ 2-19.htm

This amendment changes the bill's title to list specific new rules for Medicaid providers, including faster enrollment times, standard checks for insurance companies, and a requirement to use electronic forms.