FEBRUARY 10, 2022 | COMMUNICATION BULLETIN 2021-22 ISSUE 45 IN THIS ISSUE: Extension of Deadline for Retroactive Authorization Request Submission | Q&A Webinar for Vaya Health Network Providers | Utilization Management Questions from the Provider Q&A Webinar | Innovations Waiver Crisis Intervention and Stabilization Supports | Billing MemberSpecific and Standard Rates | SPECIAL BULLETIN COVID-19 #229: Direct Care Worker Eligibility and Portal Guidance Clarifications | Spike in Opioid/Fentanyl Overdoses in Buncombe County | Accessing Provider Support | Office Hours Sessions for Providers Transitioning from Cardinal Innovations | Technical Assistance Sessions for Providers Transitioning from Cardinal Innovations
Extension of Deadline for Retroactive Authorization Request Submission Vaya has extended the period for retroactive service authorization requests (SARs) for providers serving members in the nine counties transitioning to Vaya from Cardinal Innovations. These providers may submit SARs for retroactive authorization (to Jan. 1, 2022) on or before Feb. 25, 2022, at 5 p.m. After 5 p.m., the system will not be available for any additional authorization submissions. The previous submission deadline was Feb. 15, 2022.
PLEASE NOTE: The retroactive SAR flexibility during the transition period does not waive or eliminate any other requirements for service delivery. Providers must continue to maintain documentation standards required by their contract with Vaya and applicable State and federal laws, rules, regulations, and guidelines that govern the provision of services. If you have questions, contact Vaya’s Utilization Management team at UM@vayahealth.com or 1-800893-6246, ext. 1513.
Q&A Webinar for Vaya Health Network Providers Feb. 18, 2022, 11 a.m. – 12 p.m. Vaya’s Provider Q&A Webinars are an important source of the most up-to-date information on topics that affect Vaya network providers. The first 45 minutes of the webinar will focus on information for all Vaya providers. Information and questions specific to transitioning Cardinal providers will be addressed during the remaining 15 minutes. All network providers are encouraged 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 Vaya’s weekly Provider Communication Bulletin.
Q&A WEBINAR FOR VAYA NETWORK PROVIDERS - FEB. 18, 2022
Utilization Management Questions from the Provider Q&A Webinar During the Provider Q&A Webinar on Feb. 4, 2022, Vaya committed to provide more clarity for providers with utilization management questions. Please review the updates below: QUESTION 1: Specialized Consultative Services authorizations are completed by Care Management. Some transitioning Cardinal providers serve members with service authorizations that expired Dec. 31, 2021, or Jan. 31, 2022. There are no current authorizations posted for these members. Do we stop providing services to these members?
ANSWER 1: Member services should not be interrupted. Vaya is honoring authorizations that expired in December 2021 and January 2022. Providers are able to submit retroactive authorization requests through Feb. 25, 2022, at 5 p.m. for any concurrent requests. Innovations Waiver services that were approved by Cardinal Innovations will be honored through the end of the member’s plan year as approved by Cardinal Innovations. QUESTION 2: Medicaid “unmanaged” units for mental health/substance use services increased from 24 to 48 due to the COVID-19 pandemic. Will the units revert back to pre-COVID-19 amount of 24 units, and if so, when do you expect this to occur?
ANSWER 2: For specific information about a particular service, please contact the Utilization Management team at UM@vayahealth.com or 1-800-893-6246, ext. 1513. For general information, refer to NC Medicaid SPECIAL BULLETIN COVID-19 #226: Permanent Changes Made for Public Health Emergency Flexibilities and Plan for Sunsetting of Temporary Policies (Jan. 31, 2022). QUESTION 3: Does Vaya allow contracted provider agencies to provide Targeted Case Management (H0032)?
ANSWER 3: Providers that have Targeted Case Management (H0032 ) as part of their approved contract/ sites and services menu may provide this service. QUESTION 4: The NCDHHS-hosted provider call on Feb. 3, 2022, noted the “sunsetting” of COVID19 flexibilities. Specifically for intensive in-home (IIH) services, when do you anticipate the “sunsetting” date to occur? Could we have more clarification about IIH services/IIH telehealth services limitations?
ANSWER 4: COVID-19 flexibilities for IIH are due to sunset on March 31, 2022. Please refer to NC Medicaid SPECIAL BULLETIN COVID-19 #226: Permanent Changes Made for Public Health Emergency Flexibilities and Plan for Sunsetting of Temporary Policies (Jan. 31, 2022).
Innovations Waiver Crisis Intervention and Stabilization Supports Transitioning Cardinal Innovations providers that deliver Innovations Waiver Crisis Intervention and Stabilization Supports should be aware of a difference in code modifiers between Vaya and Cardinal Innovations. Vaya uses H2011HI for Innovations Waiver Crisis Intervention and Stabilization Supports and H2011 (without modifiers) for Mobile Crisis Management. Cardinal Innovations used H2011 (without modifiers) for Innovations Waiver Crisis Intervention and Stabilization Supports. These codes transferred into Innovations Waiver contracts incorrectly during the consolidation process. Vaya is correcting applicable provider contracts to remove H2011 and add H2011HI by tomorrow, Feb. 11, 2022. H2011 will be lapsed in Innovations Waiver contracts within the next two weeks.
Billing Member-Specific and Standard Rates Electronic visit verification (EVV) rate increases that went into effect Feb. 1, 2022, and the upcoming direct care worker (DCW) rate increases that take effect March 1, 2022, will lead to some situations in which the new Vaya standard reimbursement rate for a service is higher than some previously approved member-specific rates for the same service. In these situations, Vaya will reimburse claims at the higher standard rate.
Vaya will allow providers to revert to the standard rate when rate changes cause the standard rate to exceed a previously approved member-specific rate. Vaya will monitor rate increases and remove member-specific rate approvals for periods of time when the approved rate is lower than the new standard rate. If you have questions or need to have a member rate removed, please contact us at provider.info@vayahealth.com or at 1-800-893-6246, ext. 1512.
COVID-19 NEWS AND UPDATES SPECIAL BULLETIN COVID-19 #229: Direct Care Worker Eligibility and Portal Guidance Clarifications On Feb. 4, 2022, NC Medicaid published SPECIAL BULLETIN COVID-19 #229: Direct Care Worker Eligibility and Portal Guidance Clarifications . This bulletin extends the bonus submission deadline from Feb. 4 to Feb. 11, 2022. For providers who submitted information by the original deadline of the Jan. 31, 2022, NC Medicaid will pay by March 1, 2022.
Spike in Opioid/Fentanyl Overdoses in Buncombe County During the past week, Buncombe County has seen a spike in opioid/fentanyl overdoses, including several instances of cocaine laced with fentanyl. The Buncombe County Health Department strongly encourages agencies to distribute the overdose-reversal medication naloxone, share harm reduction information about this emerging trend, and encourage the use of fentanyl test strips on all substances. Visit the county’s website for more information on syringe services and exchange locations and hours.
REMINDER: PROVIDER SUPPORT AVAILABLE Accessing Provider Support Vaya is here to support all our network providers. You can always direct questions to: Provider Help Line: 1-800-893-6246, ext. 1512, or provider.info@vayahealth.com Claims Help Line: 1-800-893-6246, ext. 2455, or claims@vayahealth.com MIS ServiceDesk: 1-800-893-6246, ext. 1500, or servicedesk@vayahealth.com Cardinal Innovations Provider Line: 1-855-270-3327, option #3 (for Cardinal Innovations issues involving dates of service PRIOR to the Jan. 1, 2022, transition) These resources are staffed Monday-Friday, 8:30 a.m. to 5 p.m. The ServiceDesk is also available after regular business hours to unlock provider accounts in AlphaMCS as needed. Providers may also contact Member Services 24/7 at 1-800-849-6127. PLEASE NOTE: When making a request for assistance, we ask that you do not make requests through multiple support options. All provider requests for assistance are logged in our ticketing
system and responded to, whenever possible, in the order they are received. When multiple service tickets are created for the same issue, it takes longer for us to assist you.
Office Hours Sessions for Providers Transitioning from Cardinal Innovations Vaya continues to offer Provider Transition Office Hours sessions as transition needs arise. These drop-in sessions allow transitioning providers to ask questions and get answers from staff experts about Vaya’s provider network, utilization management, claims, enrollment and eligibility, care management, and AlphaMCS. Future sessions will be announced in the Provider Communication Bulletin the week prior to the event. Please note: Because sessions use a drop-in format with the potential for multiple providers to be in the same session simultaneously, we are not able to discuss member-specific issues during this time.
OFFICE HOURS – 1-2 P.M., FEB. 11, 2022
Technical Assistance Sessions for Providers Transitioning from Cardinal Innovations Vaya is offering 30-minute technical support sessions for transitioning providers who need additional assistance using AlphaMCS. Topics include navigating AlphaMCS, service authorization request (SAR) entry, claims entry, EDI enrollment, State-funded enrollment, and login issues. Providers must review the AlphaMCS educational resources offered through the AlphaMCS Portal University before requesting a technical assistance session. To register for a session, complete the online request form.
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