JULY 29, 2021 | COMMUNICATION BULLETIN 2021-22 ISSUE 8 IN THIS ISSUE: 2021 Provider and Learning Summit Post-Event Survey | Q&A Webinar for Vaya Network Providers | Change to Individual Support Services Authorization Requirements | June 2021 COVID-19 Hardship Payment Request Deadline – LAST CALL | Payment Issues Following NC Medicaid Managed Care Launch
2021 Provider and Learning Summit Post-Event Survey Thank you to everyone who attended the 2021 Provider and Learning Summit! We hope this year’s two-day summit was both informative and useful for our network providers. If you attended, please complete a brief Post-Event Survey before 5 p.m. tomorrow, July 30. Your feedback will allow us to continually enhance provider education opportunities.
Q&A Webinar for Vaya Network Providers Friday, Aug. 6, 2021, 11 a.m. – 12 p.m. Our Q&A Webinars for Vaya Network Providers take place every two weeks and are an important source of the most up-to-date information on topics that affect providers. Registration is not required. All Vaya network providers are encouraged to join.
Q&A WEBINAR FOR VAYA NETWORK PROVIDERS – AUG. 6, 2021
Change to Individual Support Services Authorization Requirements Beginning Sept. 1, 2021, all Individual Support services (T1019U4) will require prior authorization. This is a change from the current guidelines, which allow provision of up to 120 units of Individual Support services per month without prior authorization. Please note: Initial/prospective service authorization requests must include a Comprehensive Clinical Assessment (CCA) or CCA update completed within the last 30 days, as well as a personcentered plan that includes a comprehensive crisis plan and service order signature page. Concurrent authorization requests must also include a person-centered plan that indicates interventions were reviewed for effectiveness. The plan should be modified, if necessary, to reflect progress toward goals. Providers may request up to 240 units of service per month. Authorization requests should be for no longer than 90 days. If you have questions about this change, contact Vaya’s Utilization Management Team at UM@vayahealth.com or 828-225-2785, ext. 1513. For more information on current Vaya authorization guidelines, visit our website.
COVID-19 NEWS AND UPDATES June 2021 COVID-19 Hardship Payment Request Deadline – LAST CALL COVID-19 Provider Hardship Funding is focused on supporting qualified providers of Medicaid services for shortfalls experienced during the COVID-19 pandemic. Vaya will discontinue hardship funding for dates of service after June 30, 2021. Providers must submit COVID-19 Provider Hardship Funding Requests for June 2021 hardship payments by 11:59 p.m. on Saturday, July 31, 2021.
Payment Issues Following NC Medicaid Managed Care Launch Providers may be experiencing payment issues related to increased claim denials due to the transition to Medicaid managed care. To reduce claim denials and payment delays, providers should: Submit claims to the correct payer as described in the Managed Care Claims and Prior Authorizations Submission: What Providers Need to Know – Part 1 Fact Sheet Follow health plan claim submission and billing guides referenced in the Managed Care Claims and Prior Authorizations Submission: Frequently Asked Questions – Part 2 Fact Sheet Review the claim denial reason and other information on the claim, the health plan guidance documents and the NC Medicaid and NC Health Choice clinical coverage policies to identify and correct provider billing errors Contact the health plan using the Day One Provider Quick Reference Guide about claim questions For more information, please refer to the NC Medicaid bulletin Guidance for Providers Experiencing Payment Issues .
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