Q&A Webinar for Vaya & Cardinal Innovations Network Providers Friday, December 3, 2021
How the live broadcast works • You are seeing the broadcast on a 30-second delay. • Your microphone is muted throughout the broadcast. • You may ask questions at any time during the broadcast through the Q&A feature. • Questions can be seen by all attendees after they are published by the moderators. Questions submitted during the webinar will be addressed at the end of the webinar. • If multiple similar questions are received, the Q&A moderators may combine the questions into one before posting. • If you need to ask a question that is specific to your agency or the services you provide, please include your name, agency, and email address with your question.
Vaya Health | Consolidation Q&A Webinar for Vaya and Cardinal Innovations Network Providers
The moderated Q&A is available in the controls bar on your screen. Look for the bubble with the question mark.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Where can I find … Q&A Webinar Recordings and Resources:
Provider Communication Bulletin Sign-Up:
Provider Communication Bulletin Archive:
Provider Central > Learning Lab > Provider Webinars
Provider Central > Learning Lab > Sign up for PCB
Provider Central > Learning Lab > Communication Bulletins
Vaya Health | Consolidation Information Session
Today’s Vaya participants Carrie McCracken, Behavioral Health Network Operations Director Donald Reuss, Sr VP, Provider Network Operations George Ingram, VP of Physical Health & Value Based Contracting Jessica Belt, Claims Manager Justine Tullos, Provider Network Operations (Q&A moderator) Kyle Wright, Information Systems Director Lynn Widener, Director, Network Relations (Cardinal Innovations) Renee Urban, Systems of Care Manager (co-producer) Tommy Duncan, Training and Special Projects Manager (producer)
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Provider Orientation Sessions for Cardinal Innovations Providers Wednesday, Dec. 8
Thursday, Dec. 9
12 - 1:30 p.m.
Provider Orientation for Cardinal Innovations MH/SU Providers
12 - 1:30 p.m.
Provider Orientation for Cardinal Innovations I/DD Providers
The links to the Provider Orientation Webinars are also provided in issue #28 & 30 of Vaya’s Provider Communication Bulletin. Registration is not required for any of our provider Q&As.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovation Network Providers
Technical Assistance Sessions • For providers needing additional assistance with AlphaMCS • Topics include: navigating AlphaMCS, SAR entry, claims entry, EDI, State-funded member enrollment, login issues • Registration for sessions announced in the Provider Communication Bulletin next week • Providers must complete required AlphaMCS trainings before requesting technical assistance Vaya Health | Q&A Webinar for Vaya and Cardinal Innovation Network Providers
VAYA – CARDINAL INNOVATIONS CONSOLIDATION
12/02/21 Provider Communication Jan 1 Go-live
01/01/22 9 County Go-live
02/15/22 31 County Go-Live to new AlphaMCS
12/03/21 Provider Webinar
December 2021 12/08/21 Provider Orientation (MH/SU)
December TBD
•
February 2022
January 2022
12/09/21 Provider Orientation (I/DD)
Logins for AlphaMCS & SFTP Issued
January TBD • •
EDI Testing Logins for new AlphaMCS & SFTP Issued
February TBD • • •
EDI Testing Logins for Conduent HSP & SFTP Issued End User Testing
12/01/22 Tailored Plan Launch
March – November 2022
December 2022
Provider Contracts
Contract Assignment vs. Contract Amendment • All providers that are currently in good standing with Cardinal and Vaya will be offered a contract within the Vaya provider network. • Cardinal contract terminated effective Dec. 31, 2021. • Vaya contract amended to add all Cardinal sites and services effective Jan. 1, 2022. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Contract Assignment vs. Contract Amendment • Providers that have a contract with Cardinal and not Vaya will have their Cardinal contract assigned to Vaya • Providers will need to sign an assignment agreement to allow that transfer to take place. • For state funded specialty programs you may also receive a contract amendment to align any specific Vaya requirements across the provider network. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Out of Network Agreements
Out of Network Agreements • Providers with an Out-of-Network (OON) Agreement with Cardinal Innovations in which the member and services will transition to Vaya must complete a new OON Agreement with Vaya. • Affected providers must submit an OON agreement request to Vaya by Dec. 20, 2021, to ensure continuity of services. To access the OON Agreement Request, visit Vaya’s Provider Enrollment webpage.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Out of Network Agreements When submitting your request, please note the following: 1. OON Agreements cannot exceed 365 days from the requested effective date (for example, if your requested effective date is Jan. 1, 2022, the end date cannot be later than Dec. 31, 2022). 2. Once the OON Agreement Request form has been signed, it cannot be edited. This is a safety measure embedded in the online contracting platform. Please ensure that all information on the request is correct. If there is an error that is not found until post-signature, the requestor will need to submit a new request (for example, if you are requesting Child MH LVL III residential service H0019 and do not have the correct modifier that corresponds with the number of licensed beds, you will need to submit a new request with the correct modifier).
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Hospital MemberSpecific Agreements • If you have a Hospital Member-Specific Agreement with Cardinal Innovations for treatment extending beyond Dec. 31, 2021, please call Vaya’s Utilization Management (UM) team at 1-800-893-6246, ext. 1513, to enter into an OON Agreement with Vaya Health for the member(s) being served.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Provider Support Calls
Where to call for Provider Support As of Jan. 1, 2022, providers should contact the Vaya Access to Care line (1-800-849-6127) for the following activities: • • • • •
Requesting hospital discharge appointments Tracking numbers or regional referral forms that need to be completed Making a care coordination referral Mobile Crisis follow up (estimated arrival time, follow up disposition, etc.) Specialty program referrals when information is needed such as Enhanced Crisis Response
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Where to call for Provider Support • Providers that have questions about authorizations, claims or activities that occurred prior to Jan. 1st can still contact the Cardinal Innovations provider line at 855-270-3327.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
AlphaMCS
AlphaMCS • Vaya will continue to use the current AlphaMCS Managed Care Information System (MCIS) platform into 2022 for service authorization requests, claims submission, provider profiles, and enrollment of individuals receiving State-funded services. • All network providers who deliver services to members transitioning to Vaya will be required to utilize Vaya’s AlphaMCS platform to submit service authorization requests and claims for payment for dates of service on or after Jan. 1, 2022. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
AlphaMCS • A new version of AlphaMCS will be available in early 2022. Vaya will migrate all providers to the new version by Feb. 15, 2022. • As part of Vaya’s migration to Conduent’s Health Solutions Plus (HSP) MCIS platform, network providers will be required to transition to the Conduent HSP system prior to Tailored Plan launch.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
AlphaMCS Transition Support • Vaya has a number of standard protocols that will be in place throughout the transition for the providers of the nine counites that are coming to Vaya. • Provider communications- https://providers.vayahealth.com/learninglab/communication-bulletins/ • Provider webinars- links will be posted in weekly communication bulletins • Support Desk- Provider.info@vayahealth.com • Vaya will establish open virtual office hours for transition support specific to the providers of the nine counties. Providers will be able to connect with a team of Vaya subject matter experts to ask questions or get technical support for issues related to transition. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
AlphaMCS Transition Support • Get to know your assigned Provider Network Contract Manager • Provider Network Contract Managers will be reaching out to proactively connect with providers to obtain status on transition activities, validate contract details, answer questions and provide technical support for issues related to transition.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
AlphaMCS Logins & Training • To access training resources and submit service authorization requests to Vaya prior to Jan. 1, 2022, Cardinal network providers that do not already have an AlphaMCS login must submit names of staff who require an AlphaMCS login as soon as possible. Please visit the AlphaMCS page on Vaya’s Provider Central website to complete the AlphaMCS Login Request Form. • After you have been set up as a provider in AlphaMCS, Vaya will contact you regarding your login information. • We anticipate all requested AlphaMCS logins will be created by Dec. 15, 2021. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Provider Operations Manual
Vaya Provider Operations Manual Please review the Vaya Provider Operations Manual for instructions and responsibilities as a Vaya network provider. Vaya Health Provider Operations Manual
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
State-funded Member Enrollment
State-funded Member Enrollment • Vaya’s Management Information Services (MIS) department will automatically migrate the enrollment of Cardinal Innovations members who receive State-funded/non-Medicaid services to Vaya. • Providers do not need to reenroll any existing Cardinal Innovations members receiving State-funded services who are transitioning to Vaya.
• We anticipate the migration will be complete prior to Jan. 1, 2022. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Appointment Scheduling and Referral Management
Appointment Scheduling and Referral Management • If you would like to receive Member referrals from the Vaya Call Center for Comprehensive Clinical Assessments: • Appointment slots must be set up in the AlphaMCS system, when access to Alpha MCS is available. • Instructions to set up slots in Alpha MCS will be available in the Learning Lab. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Service Authorization Requests (SARs)
Service Authorizations • Providers serving members in the nine legacy Cardinal counties should begin submitting SARs to Vaya on Jan. 3, 2022. • If submitted on or before Jan. 16, 2022, Vaya will process SARs for retroactive dates of service with start dates back to Jan. 1, 2022. To help ensure timely SAR processing, please review Vaya’s Oct. 8, 2020 Provider Communication Bulletin for information about submitting complete requests. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Service Authorization Guidelines • To access updated authorization guidelines effective Jan. 1, 2022 for Vaya’s 31-county region, visit our Authorizations Guidelines webpage. • Please note that the Authorization Guidelines page includes both current Vaya authorization guidelines and a section containing the guidelines that will go into effect upon consolidation with Cardinal Innovations Healthcare (Cardinal) on Jan. 1, 2022. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
In Lieu of & Alternative Services
In Lieu of & Alternative Services • Cardinal and Vaya have a definition for the same service- providers will move to the Vaya definition and service code and rates effective Jan. 1, 2022. • Cardinal unique service- Vaya is requesting from DHB that these Cardinal specific ILOS be added to Vaya Health benefit plan. • Vaya will add these services upon final approval from NCDHHS for the consolidated Vaya region, with approval expected prior to Jan. 1, 2022. • If approval is delayed, Vaya will be unable to process these service requests and will work with providers to develop appropriate service plans for affected members. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
EPSDT
EPSDT • If you want to request services under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, please visit Vaya’s EPSDT webpage for further instruction.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Member Supplies
Member Supplies • Will Vaya be honoring the prior authorizations for member supplies, or should vendors hold supplies till new PO or authorization comes through from Vaya? • We are working on a process to add these vendors to our network and will crosswalk those services to AlphaMCS. • We do not want vendors to hold supplies. We do not want the members to experience any interruption at all. We will work with vendors to be sure all prior authorizations for Jan. 1, 2022 onward are covered and paid. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Benefit Plan Services Crosswalk
Benefit Plan Services Crosswalk • Cardinal Innovations network providers that are transitioning to Vaya may need to use a different code-modifier combination in Vaya’s AlphaMCS system. To access the current crosswalk from Cardinal Innovations service descriptions to those in the Vaya Health benefit plan, please visit Vaya’s Coverage Information webpage. • Please note that the crosswalk includes only those services with a change in the code-modifier combination or cases in which there is no exact match from Cardinal Innovations to Vaya. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Fee Schedules
Standard Fee Schedule • Vaya has published updated standard rate schedules that take effect on Jan. 1, 2022, on our Rate and Checkwrite Schedules webpage. • The rate schedules are organized into three documents by benefit plan: Medicaid (b), Medicaid (c), and Non-Medicaid/State-funded Services. • The rate schedules include the standard base rates for services and do not include any COVID-19 or public health emergency (PHE) rate enhancements. Procedure codes eligible for COVID-19/PHE rate supplements are identified on the standard rate schedules. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Standard Fee Schedule • The rate schedules also do not include any rates that are provider-specific, provider-site specific, or member-specific. For the sake of ease, certain modifiers – including AH, AJ, CR, GT, KX, and XU – are not listed separately in the rate schedules. The rates for procedure codes with these modifiers will be the same as the standard code base rate.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Provider/Member Specific Rates • Current Vaya site specific or member specific rates will continue at their established rates unless the new standard fee schedule is higher than the established rate. • Cardinal approved enhanced site specific, and member specific rates will be adopted at the established rate and loaded into the AlphaMCS system with effective dates Jan. 1, 2022. • If Cardinal and Vaya have an enhanced rate for the same site, Vaya will work individually with the provider on an agreed upon rate.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Claims Submission • Claims can be submitted to Vaya either through the AlphaMCS billing portal or electronically via 837 format. • Only claims with dates of service Jan. 1, 2022 and after should be submitted to Vaya for members from the nine joining counties. • All claims with dates of service prior to Jan. 1, 2022 should continue to be submitted to Cardinal through the CI claims system. • All providers transitioning to Vaya will need to use the Payer ID: 13010 for dates of services after Jan. 1, 2022. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
EDI Submission • If your organization has not previously submitted electronic claims to Vaya, please submit the EDI Enrollment Form to EDI@vayahealth.com no later than Dec. 1, 2021, to ensure appropriate set up and testing is complete before Jan. 1, 2022. When submitting the form, add “Cardinal Network Provider” to the subject line of your email to make certain your request is properly routed. • Please review the full list of Vaya Health-Tested Clearinghouses to confirm that your clearinghouse is successfully tested and approved for EDI transmissions.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
EDI Submission • Please note that Vaya does not contract with the Change Health (formerly Emdeon clearinghouse). Provider organizations that use Change Health for claims submission and have an agreement to pay all fees, may continue to submit claims to Vaya after Jan. 1, 2022. • Claims involving a Cardinal member and dates of service prior to Jan. 1, 2022, may be submitted to Cardinal via the Change Healthcare during the Cardinal run-out period (through Mar. 31, 2022) under your current process.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Appendix K
Appendix K Flexibilities • Appendix K Flexibilities are set to continue through July 12, 2022. • All Vaya Providers will begin using a new reporting process for Appendix K Flexibilities on January 1, 2022. • The new reporting process is designed to be much easier for providers as it will automate the entry of information and rely less on paper submissions. • Please watch Provider Communications carefully to learn more about this process. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Appendix K Reporting • To report the use of a new flexibility or an extension of a previously reported one, providers will complete the Appendix K Reporting Form available on Vaya's website. This will eliminate the need to fax or scan these forms. • We will notify providers when the form is available for use. • Providers who have previously submitted an Appendix K Reporting Form to Cardinal Innovations or Vaya will not need to resubmit information unless new flexibilities are requested. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Innovations Services
Innovations Services • Vaya published Authorization Guidelines for Innovation Waiver Services on November 30, 2021 that go into effect on January 1, 2022 for all Innovations Waiver service providers. • Please see those authorization guidelines on the Vaya website here: https://providers.vayahealth.com/authorizationbilling/authorization-info/authorization-guidelines/
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Employer of Record (EOR) • Vaya is working to complete a communication that will be sent directly to each member or legally responsible person who is currently participating in EOR with Cardinal Innovations. • This communication will share any changes in processes for requesting start up and yearly supplies and equipment.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Community Navigator • The Employer of Record (EOR) Community Navigator and Agency with Choice (AWC) codes used by Cardinal Innovations are listed below and will end on Dec. 31, 2021. For all expiring codes in the list, please use T2041 Community Navigator: Monthly for authorization requests and billing. • • • • • • • • • •
T2041 U6 - Community Navigator Annual Information Session on Self Direction T2041 U6 UA Community Navigator Annual Information Session on Self Direction (AWC members) T2041 U6 UB Community Navigator Annual Information Session on Self Direction (EOR members) T2041 UC Community Navigator Annual Information Session on Self Determination & Rights T2041 UC UA Community Navigator Annual Information Session on Self Determination & Right (AWC) T2041 UC UB Community Navigator Annual Information Session Self Determination & Rights (EOR) T2041 U6 U4 Community Navigator Annual Information Session on Self Direction (b)(3) T2041 U6 U4 UA Community Navigator Annual Information Session on Self Direction (AWC) (b)(3) T2041 UC U4 Community Navigator Annual Information Session on Self Determination & Rights (b)(3) T2041 UC U4 UA Community Navigator Annual Information Session on Self Determination & Rights (AWC) (b)(3)
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Credentialing
Credentialing Update Cardinal • It is Cardinal Innovations' consistent goal throughout the consolidation period to provide an adequate network of providers to service Cardinal Innovations members. • Credentialing applications that were received prior to Oct. 1, 2021 are being processed through completion. • Application requests received after Oct. 1, 2021 are reviewed based on addressing a member specific need. • Cardinal Innovations will review the application in the instance where there is not a provider in the network available to service the member. Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Credentialing Update Cardinal • A final determination to make an exception will be determined by our contracting department. • If the provider is already contracted/credentialed with Cardinal Innovations, that credentialing information will be passed directly to Vaya without interruption as part of the consolidation process effective Jan. 1, 2022.
Vaya Health | Q&A Webinar for Vaya and Cardinal Innovations Network Providers
Q&A SESSION
Questions? Thoughts? Ideas?
Upcoming Q&A Webinars DECEMBER 2021 Wednesday, Dec. 8
12 - 1:30 p.m.
Provider Orientation for Cardinal MH/SU Providers
Thursday, Dec. 9
12 - 1:30 p.m.
Provider Orientation for Cardinal I/DD Providers
Friday, Dec. 17
11 a.m. - 12 p.m.
Q&A Webinar for Vaya and Cardinal Innovations Network Providers
JANUARY 2022 Friday, Jan. 7
11 a.m. - 12 p.m.
Q&A Webinar for Vaya Providers (Vaya/Cardinal consolidated provider network)
Friday, Jan. 21
11 a.m. - 12 p.m.
Q&A Webinar for Vaya Providers (Vaya/Cardinal consolidated provider network)
Need support? We’re here for you.
provider.info@vayahealth.com