OCTOBER 8, 2020 | COMMUNICATION BULLETIN ISSUE 24 IN THIS ISSUE: Q&A Webinar for Vaya Health Network Providers | Vaya Provider Summit Postponed | Utilization Management Unable to Process and Administrative Denial Process | QPR – Suicide Prevention Web-Based Training
Q&A Webinar for Vaya Health Network Providers Oct. 16, 2020, 11 a.m. – 12 p.m. Q&A Webinars for Vaya Network Providers take place every two weeks and are an important source of the most up-to-date information for providers. Registration is not required. All Vaya network providers are encouraged to join.
Q&A WEBINAR FOR VAYA NETWORK PROVIDERS
Vaya Provider Summit Postponed Every year, we look forward to hosting Vaya’s Provider Summit and creating a memorable event for everyone who attends. However, due to the COVID-19 public health crisis and the amount of time in the coming months our staff will be dedicated to writing a successful Tailored Plan RFA response, we have chosen to postpone this year’s Provider Summit until early spring 2021. If you have any questions, contact Training and Special Projects Manager Tommy Duncan at tommy.duncan@vayahealth.com. Stay tuned for more details. We apologize for any inconvenience this may have caused.
Utilization Management Unable to Process and Administrative Denial Process Administrative reviews of Service Authorization Requests (SARs) ensure that requests are valid, complete and ready for clinical review. When Vaya’s administrative review determines that a request is invalid or incomplete, Utilization Management staff issue either an “administrative denial” or an “unable to process” decision. Common mistakes in SAR submissions that result in one of these decisions include:
Administrative Denial examples: 1. Missing signatures on the Person-Centered Plan (PCP) 2. Missing LOCUS/CALOCUS, CANS or ASAM scores 3. Missing Child and Family Team (CFT) attestation on PCP (when applicable) 4. Missing documentation for ICF-IDD (examples: missing qualifying diagnosis for Innovations members on ISP/member Care Plan, missing psychological evaluation on initial ICF admission, missing psychological evaluation on initial new requests for IDD services) 5. Missing alternative signature documentation for the qualified professional, care manager or legally responsible person for Innovations or (b)(3) Deinstitutionalization services as allowed by Appendix K Unable to Process examples: 1. Missing service order 2. Missing Comprehensive Clinical Assessment (CCA), when required by Clinical Coverage Policy 3. Missing Certificate of Need 4. Missing Person-Centered Plan (PCP) 5. Missing Level of Care (LOC) forms for Innovations services 6. Missing Comprehensive Crisis Plan 7. Missing evaluations/prescription/letter of medical necessity (LMN) needed for Home Modification/Vehicle Modification/Assistive Technology Equipment and Supplies Assistive Technology Equipment and Supplies (ATES) needs 8. Missing Non-Medicaid/state-funded benefit plan (also known as target population) or incorrect benefit plan identified Please note the lists above are not exhaustive. There may be other circumstances that result in an administrative denial or an unable to process decision. Please contact Utilization Management with any questions or concerns at 1-800-893-6246, ext. 1513.
TRAINING OPPORTUNITIES Question, Persuade, Refer (QPR) – Suicide Prevention Web-Based Training Multiple dates through December 2020 Vaya's Provider and Community Education Team will offer free, web-based “Question, Persuade, Refer” (QPR) suicide prevention trainings through December 2020. Trainings will be offered on the second Tuesday (2:30 – 4:30 p.m.) and fourth Tuesday (9 – 11 a.m.) of each month. Each training is limited to 30 participants. To register for an upcoming QPR training, email Kelly Wolf, Provider and Community Educator, at kelly.wolf@vayahealth.com.
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