West Virginia rehabilitation professional billing —
85 CSR 15, and a small market.
85 CSR 15 defines the “rehabilitation professional” in West Virginia, and the market it supports is small. Encova, the privatized former state fund, and the private carriers pay both rehabilitation professionals and nurse case managers.
The facts, before the pitch.
How billing works in West Virginia
- Who you bill
- The carrier or TPA.
- What you send
- CMS-1500 or invoice.
- The channel
- Direct.
- Fee basis
- No published rate we have verified. Ask the West Virginia Offices of the Insurance Commissioner before anyone quotes you one — including us.
- The clock
- Not a deadline we have verified for West Virginia. Ask the West Virginia Offices of the Insurance Commissioner, and read the payer’s own contract, before you rely on a date.
The system. Rehabilitation professionals are defined by rule; a small market alongside nurse case management.
Where the rules are written. 85 CSR 15.
Nurse case managers in West Virginia are supported today. Invoice-based case-management billing needs no state-specific setup — it works here now. Private vocational rehabilitation in West Virginia is a different story, told plainly further down, and there is a West Virginia voc-rehab list you can join.
Your week, in West Virginia’s documents.
A defined professional role in a small market, and mountain miles between appointments.
- 7:40 a.m.Calls on three files before the drive.Entered as they end, with claim numbers attached.
- 11:00 a.m.Appointment attended, wait time, 73 mountain miles.Travel time and mileage as their own lines.
- 2:10 p.m.Monthly report for an Encova file.Written once, out of the weekly logs it already wrote.
- 4:30 p.m.Invoices out and receivables aging by payer.One list on Tuesday morning.
Every one of those rows is typed once, as it happens. The daily log writes itself as you go, the weekly narrative log builds in your own Word template, a CMS-1500 fills with the right units and the right payer block where a payer wants one — and where your state bills on its own form or an invoice, the dated, timed, priced lines that go on it come off the grid, and the receivable is tracked from the moment the bill leaves. The whole chain →
85 CSR 15 names the profession. The volume is another question.
West Virginia does define the rehabilitation professional by rule, which puts it a step ahead of the states that fund nothing at all. What it does not have is the volume of a registry state like North Carolina or Georgia.
So this page sells the thing that runs every week: nurse case management, invoiced to Encova and the carriers. If you carry rehabilitation-professional files as well, the same grid produces both bills.
Who pays you in West Virginia.
Encova, the privatized former state fund, carries much of West Virginia, with the national carriers and TPAs behind it.
West Virginia payers
- Encova (privatized former state fund)
- Private carriers
National carriers you will meet
- Travelers
- The Hartford
- AmTrust
- Zurich
- Chubb
- Berkshire Hathaway
- Liberty Mutual
- AF Group / Accident Fund
- Old Republic
- Great American
TPAs that send the referrals
- Sedgwick
- Gallagher Bassett
- ESIS
- Helmsman
- Broadspire
- CorVel
- TRISTAR
- CCMSI
- Athens Administrators
One check, many claimants. Whichever of these names is on the envelope, the check covers a dozen files at once. You record it once, tick the bills it pays, and anything short is flagged with the exact gap and the original form attached, ready to rebill. How that screen works.
Billing addresses and submission preferences go stale faster than any page can keep up, so we publish them only where we keep them current — today that is Ohio’s nine MCOs. Your West Virginia payers and their submission preferences get set up during onboarding, from your own files.
Case files, adjusters, mileage, receivables.
Nurse case management billing works in West Virginia today, and the same activity grid handles rehabilitation-professional files under 85 CSR 15 when they arrive.
The activity grid
Field visit, telephonic call, wait time at the appointment, the miles there and back — logged once, with the claim number, the adjuster and the referral source attached as you type.
The log behind the bill
A weekly narrative log per case file, dated and grouped, reproducing your own Word template — and where a payer wants a CMS-1500 the software fills one. It does not write an invoice document today: the dated, timed, priced lines that go on yours come off the grid.
Aging by payer
Encova (privatized former state fund), the carriers and the TPAs, each with billed, paid and still-owed, and an aging list that names who is sitting on your money.
It is the same week an Ohio vocational rehabilitation case manager works, in different nouns: case files instead of claimants, adjusters instead of MCO coordinators, billable hours and mileage instead of W-codes. Thirty-odd billable touches a day either way, and the same four documents behind every one of them. The nurse case manager page has the whole workflow.
Where the rules actually live.
Ask the West Virginia Offices of the Insurance Commissioner for
- the current text of 85 CSR 15
We have not published a verified link set for West Virginia yet, and we would rather send you nowhere than somewhere out of date. If you have the current documents, send them over — admin@onservice.us.
How we keep this page honest
Every fact above is transcribed from the West Virginia Offices of the Insurance Commissioner or the statute named, dated July 2026, and reviewed when the agency republishes. Where we have not verified something we say so rather than filling the gap.
Found something out of date? Tell us and we will fix it the same week: (302) 202-3172 or admin@onservice.us.
See a West Virginia caseload run itself.
Fifteen minutes, a case-management caseload on screen, and an honest answer about what West Virginia voc rehab would need. Or join the West Virginia voc-rehab list and we will write to you when there is something real to show.
There is a phone number and a person answers it: (302) 202-3172.
States that work like West Virginia
Questions, answered.
What is a "rehabilitation professional" under 85 CSR 15?
A role West Virginia defines by rule. It is a real professional category; what it is not is a market with the volume of a registry state. We describe the rule and let you judge the market.
Can the software handle both kinds of file?
Yes — one activity grid, and the invoice that comes out of it follows the file rather than your memory.
Is there a West Virginia fee schedule for this work?
Not one we have verified, so no rate is printed here.
I also carry Ohio files across the river.
Ohio is W-codes, nine MCOs, a CMS-1500 and a one-year clock — a genuinely different system, and the one this software was built inside. Ohio.
Where does my data live?
On your computer, in your own folders.
See your own week run itself.
We load your state’s codes before the call, so you are looking at a caseload like yours inside the first two minutes — not a slide deck.