Vaya Health
NC Medicaid Direct PIHP and Provider Portal Go-Live Resource Guide What should I expect? What is happening on April 1, 2023?
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Vaya Health (Vaya) will begin managing services for behavioral health, intellectual/developmental disabilities (I/DD), and traumatic brain injury (TBI) for our current population and the NC Medicaid Direct population under the new NC Medicaid Direct Prepaid Inpatient Health Plan (PIHP). Vaya will launch our new Provider Portal. The portal will be the main interface for all provider activity with Vaya, replacing AlphaMCS. AlphaMCS will sunset at 5 p.m. on March 31, 2023. Providers will have read-only access for a short period of time. Vaya will notify providers when read-only access will end in a future Provider Communication Bulletin. Providers will begin using the 10to8 appointment scheduling application to manage all slots provided to Vaya for member and recipient appointments.
What is Vaya’s NC Medicaid Direct PIHP?
NC Medicaid Direct is North Carolina’s Medicaid program for beneficiaries who are not enrolled in managed care plans, such as Standard Plans or Tailored Plans. The Medicaid Direct population includes children in foster care, Medicaid/Medicare dual-eligible individuals, Community Alternatives Program for Children (CAP/C) and Community Alternatives Program for Disabled Adults (CAP/DA) participants, and others. Under NC Medicaid Direct, NC Medicaid (the Division of Health Benefits, or DHB) will continue to manage physical health, pharmacy, and non-emergency medical transportation services for these beneficiaries. Vaya and the state’s other LME/MCOs will manage their behavioral health, I/DD, and TBI services. For more information about NC Medicaid Direct, see the NCDHHS fact sheet or visit the NC Medicaid website. What activities will move to the new Vaya Provider Portal?
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Enrollments, updates, and discharges for recipients of State-funded Services Authorization requests, effective May 1, 2023 (this 30-day grace period will help ensure providers are set up correctly in the new portal and able to access needed information during the transition from AlphaMCS) Direct claims submission (non-837 files) for institutional (UB-04) and professional (CMS-1500) claims, as well as Remittance Advice (RA) reports Provider grievance and appeal submission User login assignment through the designated System Access Administrators (SAAs) interface Provider access to general documents and targeted resources COMING SOON: access to provider-specific performance reports
What does my organization need to do immediately? ACTION NEEDED: Vaya Provider Portal Systems Access Administrator (SAA) Designation
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If your organization has not designated a Systems Access Administrator (SAA), please complete the Network Provider SAA Designation Form immediately. Vaya does not issue Provider Portal logins for provider organization
Vaya Health | NC Medicaid Direct PIHP and Provider Portal Go-Live Resource Guide Provider Network Operations | Rev. 03.30.2023 Copyright © 2023 Vaya Health. All rights reserved. Version 1.0
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staff other than the SAA, and provider organizations without a designated SAA will not have access to the Provider Portal on April 1, 2023. (SAA login credentials are typically issued within five business days). The SAA is responsible for creating and maintaining user accounts for their organization staff. Designated SAAs may request technical assistance from Vaya’s Service Desk at ServiceDesk@vayahealth.com or 1800-893-6246, ext. 1500. All other users should contact their organization’s SAA for assistance. For more help using the new portal, refer to the job aids posted on the Resources page of the Vaya Provider Central website.
ACTION NEEDED: Sign up for Vaya’s weekly Provider Communication Bulletin
We encourage all provider staff to read our weekly Provider Communication Bulletins. Sign up today on Vaya’s Provider Central website. Please note that all Vaya network providers are contractually required to receive the Provider Communication Bulletin and adhere to all information and requirements communicated in the bulletin. ACTION NEEDED: Attend Vaya’s Provider Touchpoint webinars
The Provider Touchpoint webinar is your source for the latest information on topics that affect Vaya Health network providers. We encourage all network providers to attend. Registration is not required. The link to each webinar is published both the week prior to and the week of the event in the Provider Communication Bulletin. Access recordings of previous Provider Touchpoint webinars on our Provider Central website. ACTION NEEDED: 10to8 Appointment Scheduler
The 10to8 scheduling application will replace the AlphaMCS slot scheduler beginning April 1, 2023. 10to8 allows registered providers to add available appointment slots in a scheduler. Vaya Member and Recipient Services staff will use 10to8 to schedule appointments, relay member/recipient-specific information to the provider, and send appointment reminders. If your provider organization is interested in using 10to8, submit a completed 10to8 Access Request Form. For more information, email ServiceDesk@vayahealth.com.
What do I need to know about authorizations and claims? Prior Authorization Flexibilities for Medicaid Services
Prior authorization requirements are waived for most Medicaid services during April 2023. For more information, please see Provider Communication Bulletin 2022-23, Issue 44 (March 15, 2023). Prior Authorization Flexibilities for State-funded Services
On April 1, 2023, Vaya will implement authorization flexibilities for State-funded Services that typically require prior authorization. Providers serving recipients with active service authorizations on March 31, 2023, that expire in April do not need to submit requests to continue these services through the end of April or for payment of claims related to these services during April. Prior authorization requirements will not change for new episodes of care that begin in April 2023 or for dates of service beginning on or after May 1, 2023. Vaya will allow retrospective authorization requests for State-funded Services with dates of service in May or June 2023 to be entered through June 30, 2023. Vaya Health | NC Medicaid Direct PIHP and Provider Portal Go-Live Resource Guide Provider Network Operations | Rev. 03.30.2023 Copyright © 2023 Vaya Health. All rights reserved. Version 1.0
Please note that inpatient psychiatric facilities utilizing three-way bed funding must continue to submit admission notifications and requests for continued stay using the processes described on the SAR Process page of Vaya’s Provider Central website. For more information about the authorization flexibilities, please visit the SAR Process webpage. Claims Submission Guidance
To simplify claims processing, Vaya requests that all professional claims (CMS1500 or 837P, non-institutional) with dates of service prior to April 1, 2023, are billed separately from claims with dates of service on or after April 1, 2023. Please note this includes all electronic visit verification (EVV) related claims. For more information, email ServiceDesk@vayahealth.com. 837 Claims File Submissions
Beginning April 1, 2023, provider organizations that submit 837 claim files to Vaya will submit through the CrushFTP platform. If you currently submit 837 claims files and have not received your login credentials for Crush FTP, email ServiceDesk@vayahealth.com.
What support is available from Vaya? Vaya’s Command Center for Providers
Any launch of a new health plan, plus an online portal and other applications, comes with challenges and “speed bumps” on the way to a smooth road ahead. Vaya’s Command Center is offering providers targeted support during the transition to address any concerns and quickly resolve issues that may arise. Open Office Hours
Our support includes virtual Open Office Hours webinars for providers three days per week during April and May 2023. Providers are invited to drop in to ask a question on any topic related to doing business with Vaya. Subject matter experts on multiple topics will be available in each webinar session to answer your questions. Check out our weekly Provider Communication Bulletin for a schedule and links to upcoming webinars. Provider Portal Trainings
Vaya is offering multiple trainings to help providers navigate the new Vaya Provider Portal. Registration is not required. Dates and times for all Provider Portal trainings are published in the weekly Provider Communication Bulletin. What other support is available?
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Contact your assigned Provider Network Contract Manager Email provider.info@vayahealth.com Call the Provider Support Service Line, available Monday to Saturday, 7 a.m. to 6 p.m., at 1-866-990-9712 Refer to our Provider Portal job aids
Vaya Health | NC Medicaid Direct PIHP and Provider Portal Go-Live Resource Guide Provider Network Operations | Rev. 03.30.2023 Copyright © 2023 Vaya Health. All rights reserved. Version 1.0