MARCH 9, 2023 | COMMUNICATION BULLETIN 2022-23 ISSUE 43 IN THIS ISSUE: Provider Touchpoint | NCDHHS Delays Mobile Crisis Management Clinical Coverage Policy and State Plan Update | Vaya Clinical Coverage Policy for Imaging Services | Notification to DME Vendors | Action Needed: 837 Claims File Submissions | State Opioid Response III (SOR3) Grant | Upcoming Provider Portal Trainings | Person-Centered Plan Training | Residential Bedboard Phase 1 Training
ALL NETWORK PROVIDERS Provider Touchpoint March 17, 2023, 11 a.m.-12 p.m. Provider Touchpoint 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.
PROVIDER TOUCHPOINT – MARCH 17, 2023
NCDHHS Delays Mobile Crisis Management Clinical Coverage Policy and State Plan Update NCDHHS has rescinded NCDHHS LME/MCO Joint Communication Bulletin #J443 (Feb. 15, 2023) which outlined new requirements for Mobile Crisis Management for both Medicaid Clinical Coverage Policy 8A and State-Funded Policy effective Feb. 15, 2023. The Department has replaced the communication with NCDHHS LME/MCO Joint Communication Bulletin #J444 (March 8, 2023) delaying the implementation of the new requirements for an undetermined period. If you have questions, contact Stephanie Wilson at 919-527-6604 or stephanie.wilson@dhhs.nc.gov.
Vaya Clinical Coverage Policy for Imaging Services
On Feb. 24, 2023, Vaya posted the Clinical Coverage Policy for Imaging Services that will be in effect at Tailored Plan launch on Oct. 1, 2023. Providers who will be requesting or providing imaging services should review the policy to learn which services will require prior authorization and what information will be required in a service authorization request (SAR). Please note: Although the NCDHHS recently updated NC Clinical Coverage Policy 1K-7 to eliminate requirements for prior authorization, Vaya’s policy maintains these requirements. If you have questions, call Vaya’s Utilization Management Department at 828-225-2785, ext. 1513.
Notification to DME Vendors Durable medical equipment (DME) includes a wide range of items that are appropriate for use in the home as well as medical supplies that typically are not reused. Although the Social Security Act does not define DME for the purposes of Medicaid, Section 1905(a)(7) authorizes medical supplies, equipment, and appliances as a mandatory home health care benefit. Section 1905(a)(11) also authorizes coverage and payment for certain supplies and equipment used during physical, occupational, and speech-language therapy. Providers should seek coverage of DME through Medicaid B before requesting coverage from Vaya through the NC Innovations Waiver. The Innovations Waiver may cover certain DME and supplies not coverable through Medicaid B. DME vendors submitting requests to Vaya for coverage through the Innovations Waiver must include documentation of a thorough effort to receive coverage through Medicaid B. If you have questions, either open a ticket with NCTracks or call the Medicaid Contact Center at 1888-245-0179. Please see Clinical Coverage Policy 5A – Attachment D for full details.
BEHAVIORAL HEALTH, I/DD, AND TBI PROVIDERS Action Needed: 837 Claims File Submissions Beginning April 1, 2023 with the Provider Portal go-live, provider organizations that submit 837 claim files to Vaya will do so through the platform CrushFTP. To prepare for the transition, these providers must identify which staff members will require access to the platform and submit an EDI/837 Contacts Form identifying those individuals no later than March 17, 2023. If you have questions, email ServiceDesk@vayahealth.com .
State Opioid Response III (SOR3) Grant NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Abuse Services is accepting provider applications for the State Opioid Response III (SOR3) Grant. The grant aims to: Engage opioid prevention strategies that impact individuals under the age of 18 in historically marginalized or underserved populations. Help implement evidence-based prevention education curricula with youth under the age of 18 who have a greater potential of engaging in substance misuse and developing opioid use disorder. Develop resource equity, increase connections to care, and implement opioid use prevention programming for affected communities’ youth as a continued response to the opioid crisis in North Carolina. Interested agencies must be nonprofit and serve one or more of the following high need counties: Ashe, Avery, Bladen, Burke, Buncombe, Caldwell, Cherokee, Clay, Craven, Cumberland, Davidson, Edgecombe, Graham, Guilford, Haywood, Jackson, Lee, McDowell, New Hanover, Randolph,
Richmond, Rowan, Surry, Swain, Transylvania, Vance, Wayne, and Wilkes. Applications must be emailed as a PDF to Angela Maxwell at angela.maxwell@dhhs.nc.gov by 5 p.m. on March 23, 2023. More information about the grant and application process is available here. Questions should be addressed to Paige Salters at paige.salters@dhhs.nc.gov. You may also contact James Collins, Vaya Opioid Coordinator, for assistance at james.collins@vayahealth.com.
LEARNING OPPORTUNITIES Upcoming Provider Portal Trainings Beginning April 1, 2023, all enrollment, authorization, and claims activities will move from AlphaMCS to our new Provider Portal. To support network providers in this transition, we are offering multiple trainings to assist in navigating the new Provider Portal. Registration is not required for these trainings. Provider Portal: Submitting Claims March 15, 2023, 2-4:30 p.m. Click here to join the meeting Provider Portal: Enrollment, Authorizations, Documents, and Resources March 14, 2023, 1 -3:30 p.m. Click here to join the meeting March 21, 2023, 9:30 a.m.-12 p.m. Click here to join the meeting Vaya will offer additional trainings and technical assistance (TA) sessions after the Provider Portal launches on April 1, 2023. All trainings and TA sessions will be announced in future Provider Communication Bulletins.
Person-Centered Plan Training April 5, 2023, 9 a.m.-1 p.m. May 9, 2023, 9 a.m.-1 p.m. June 7, 2023, 9 a.m.-1 p.m. NCDHHS is hosting additional person-centered planning training sessions as part of the series the Department announced in NCDHHS LME-MCO Joint Communication Bulletin #J440 (Dec. 13, 2022). Registration is open for sessions in April, May, and June. For more information and to register, visit NCDHHS’s Person-Centered Training webpage.
Residential Bedboard Phase 1 Training Vaya is partnering with Rapid Resources for Families (RRFF) to implement a residential Bedboard to streamline referrals for residential treatment. Vaya will implement the Bedboard in three phases with training offered for each phase. Providers only need to attend one training in advance of the go-live date for their respective phase. Providers who are already using the Bedboard and are in good standing with RRFF do not have to attend a training. The scheduled go-live date for Phase 1 (Therapeutic Foster Care and emergency placements) is April 10, 2023. Trainings will be offered: Monday, March 13, 2023, 12 p.m. Register
Tuesday, March 14, 2023, 10 a.m. Register Thursday, March 16, 2023, 10 a.m. Register Phase 2 and 3 training dates and links will be announced in a future communication bulletin. The golive dates for these phases are: Phase 2 (Level II group, Level III, and Level IV) – May 8, 2023 Phase 3 (Psychiatric Residential Treatment Facility) – June 6, 2023
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