MARCH 30, 2023 | COMMUNICATION BULLETIN 2022-23 ISSUE 47 IN THIS ISSUE: Provider Touchpoint | AlphaMCS Sunset and Move to Vaya Provider Portal | NEW: NC Medicaid Direct PIHP and Vaya Provider Portal Go-Live Providers Resource Guide | Open Office Hours for Providers | Provider Portal Updates: Passthrough Notifications During Changeover, Provider Portal Systems Access Administrator and Technical Support, and Provider Portal Trainings | 10to8 Appointment Scheduler | Prior Authorization Flexibilities for State-funded Services on April 1, 2023 | Supervised Living – Low: Change in Required Documentation | JCB #J449: State-Funded I/DD & TBI Residential and Community-Based Day Services Sunsetting Extension | NC Medicaid Direct PIHP “In Lieu of” Services | Long-Term Community Supports ‘In Lieu Of’ Service Updates | Reminder: Transition to NC Medicaid Direct PIHP Claims Submission Guidance | Residential Bedboard Phase 2 Training
ALL NETWORK PROVIDERS Provider Touchpoint March 31, 2023, 11 a.m.-12 p.m. 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.
PROVIDER TOUCHPOINT – MARCH 31, 2023
AlphaMCS Sunset and Move to Vaya Provider Portal The AlphaMCS portal will sunset and become read-only at 5 p.m. March 31, 2023. After this time, providers will no longer be able to add data to AlphaMCS, including client update requests, enrollments, authorization requests, discharges, and claims (either submitted through AlphaMCS or EDI 837 files). Beginning April 1, 2023, all member and recipient updates, recipient enrollments, authorization requests, and claims activities will move to the Vaya Provider Portal . Read below for more information about the change.
NEW: NC Medicaid Direct PIHP and Vaya Provider Portal GoLive Providers Resource Guide Need a handy guide to the information you need to know for this weekend’s new health plan and Provider Portal launch? Review our new NC Medicaid Direct PIHP and Vaya Provider Portal Go-Live Providers Resource Guide to make sure your provider organization is prepared for the changes beginning April 1, 2023.
Open Office Hours for Providers Beginning Monday, April 3, 2023, Vaya will hold 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. Upcoming open office hours: April 3, 2023, 11 a.m.-1 p.m. April 4, 2023, 9-11 a.m. April 5, 2023, 11 a.m.-1 p.m. April 6, 2023, 1-3 p.m. April 11, 2023, 9-11 a.m. April 12, 2023, 11 a.m.-1 p.m. April 13, 2023, 1-3 p.m. Note that member/recipient protected health information (PHI) may not be discussed during these calls due to the presence of multiple Vaya staff and other providers. Please reference upcoming Provider Communication Bulletins for additional dates and times.
Provider Portal Updates Passthrough Notifications During Changeover To submit a passthrough notification for payment of services to Vaya between 5-11:59 p.m. tomorrow, March 31, 2023, send a paper SAR by fax only to 828-348-4141 . For more information, visit the SAR Process page of Vaya’s Provider Central website.
Provider Portal Systems Access Administrator and Technical Support As announced in Provider Communication Bulletin 2022-23 Issue 17 (Oct. 6, 2022) and in emails to all network provider contract signatories, each provider organization is required to identify one systems access administrator (SAA) within their agency. The SAA is responsible for managing the creation, support, and deactivation of user access to the Provider Portal for users within your organization. If your organization has not designated an SAA, please complete the Network Provider SAA Designation Form immediately . Vaya does not issue Provider Portal logins for provider organization staff other than the SAA, and provider organizations without a designated SAA will not have access to the Provider Portal on April 1, 2023. Designated SAAs may request technical assistance from Vaya’s Service Desk at ServiceDesk@vayahealth.com or 1-800-893-6246, 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.
Provider Portal Trainings Vaya continues to offer trainings to help providers navigate our Provider Portal. Registration is not
required. To participate, click the link below: Provider Portal: Submitting Claims, April 6, 2023, 1-3:30 p.m. Join online. Provider Portal: Submitting Claims, April 12, 2023, 1:30-4 p.m. Join online. Provider Portal: Enrollment, Authorizations, Documents, and Resources , April 5, 2023, 1:30-4 p.m. Join online. Provider Portal: Enrollment, Authorizations, Documents, and Resources, April 13, 2023, 3-5 p.m. Join online.
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 .
BEHAVIORAL HEALTH, I/DD, AND TBI PROVIDERS Prior Authorization Flexibilities for State-funded Services on April 1, 2023 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. 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.
Supervised Living – Low: Change in Required Documentation As of April 1, 2023, Vaya will no longer require submission of a person-centered plan with requests for initial authorization of Supervised Living – Low (YP710) services. Providers must continue to complete and maintain a valid treatment plan as soon as possible following admission to cover all dates of service. For more information, email Vaya’s Utilization Management Team at UM@vayahealth.com or call the Provider Support Service Line at 1-866-990-9712.
JCB #J449: State-Funded I/DD & TBI Residential and Community-Based Day Services Sunsetting Extension
To align with the launch of Tailored Plans on Oct. 1, 2023, NCDHHS has extended the sunsetting date for State-Funded I/DD and TBI Residential and Community-Based Day Services from March 31, 2023, to Sept. 30, 2023. Read more in LME/MCO Joint Communication Bulletin # J449 (March 28, 2023).
NC Medicaid Direct PIHP 'In Lieu of' Services On April 1, 2023, new and revised Vaya “In Lieu of” Services (ILOS) will go into effect with the launch of the NC Medicaid Direct PIHP. Read more in the memo linked below: Memo: NC Medicaid Direct PIHP “In Lieu of” Services (March 30, 2023)
Long-Term Community Supports 'In Lieu of' Service Updates The Centers for Medicare & Medicaid Services (CMS) and NCDHHS have approved Vaya’s revised Long-Term Community Supports (LTCS) ILOS definition, which lowers the service eligibility age to 16. Memo: Long-Term Community Supports “In Lieu of” Service (March 30, 2023)
Reminder: Transition to NC Medicaid Direct PIHP Claims Submission Guidance Beginning April 1, 2023, Vaya will launch our NC Medicaid Direct PIHP. 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 .
LEARNING AND PARTICIPATION OPPORTUNITIES Residential Bedboard Phase 2 Training Vaya and Rapid Resources for Families (RRFF) are partnering to increase usage of a residential "bedboard” to streamline residential treatment referrals. Vaya will implement the bedboard in three phases, with training offered for each phase. Providers should attend one training session only 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 need to attend training. The scheduled go-live date for Phase 2 (Level II group, Level III, and Level IV) is May 8, 2023. Trainings will be offered on the following dates and times: April 6, 2023, 10 a.m. Register online. April 6, 2023, 2 p.m. Register online. April 10, 2023, 1 p.m. Register online. April 11, 2023, 10 a.m. Register online. April 11, 2023, 1 p.m. Register online. April 12, 2023, 2 p.m. Register online. April 13, 2023, 9:30 a.m. Register online. April 13, 2023, 12:30 p.m. Register online. April 13, 2023, 2:30 p.m. Register online. A future Provider Communication Bulletin will include training dates and links for Phase 3 (Psychiatric
Residential Treatment Facility), scheduled to go live June 6, 2023.
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