Processes and Frequently Asked Questions for Vaya Health 1915(i) Services

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Vaya shares information about 1915(i) processes with service providers and TCM provider entities through their weekly Provider Communication Bulletin and biweekly Provider Touchpoint Webinar.

These resources are available 24/7 on Vaya’s Provider Central website through Vaya’s searchable Provider Communication Bulletin archive and Provider Touchpoint recordings and slide decks.

Vaya’s public website includes general information about 1915(i) services, including hyperlinks to multiple NCDHHS 1915(i) resources.

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In addition to Vaya’s Provider Communication Bulletin archive and Provider Touchpoint recordings and slide decks, service providers and care managers have 24/7, on-demand access to Vaya’s 1915(i) Waiver Training module, developed by Vaya to provide education about 1915(i) processes and associated NC Medicaid Clinical Coverage Policies, through the Vaya Learn Portal.

Additionally, service providers and TCM provider entities may request a one-on-one meeting for support by contacting their Provider Network Contract Manager, TCM Oversight Specialist, or 1915i@vayahealth.com.

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Providers may request individual meetings for support or guidance through their Provider Network Contract Manager or TCM Oversight Specialist.

Vaya’s biweekly Provider Touchpoint webinars also include 1915(i) updates and guidance for providers, as well as time for Q&A.

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Vaya hosts a monthly TCM Oversight Technical Assistance call that allows TCM providers to ask questions about 1915(i) processes and receive support.

TCM provider entities can request individual meetings for additional support and guidance through their Provider Network Contract Manager or TCM Oversight Specialist.

Vaya’s biweekly Provider Touchpoint webinars also include 1915(i) updates and guidance for care managers, including time for Q&A.

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Vaya encourages providers to send questions to 1915i@vayahealth.com.

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TCM Providers should submit assessments directly to Carelon and send a copy of the assessment to 1915i@vayahealth.com.

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Provider-based care managers should receive notification directly from Carelon regarding member eligibility.

Provider based care managers may email 1915i@vayahealth.com for updates on a member’s eligibility status.

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All care managers should review the member’s health record to identify any current or historical contact information.

If the member has a current service provider, the care manager should work with that provider to engage the member.

If the member is still unreachable, the care managers should follow routine “Unable to Reach” best efforts, including mailing the member a letter.

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Care managers who have difficulty reaching a member can email 1915i@vayahealth.com for assistance.

In addition, TCM provider entities can request individual meetings with a Vaya subject matter expert for support and guidance through their Provider Network Contract Manager or TCM Oversight Specialist.

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Provider-based care managers can access a list contracted 1915(i) providers using the Find a Provider feature on Vaya’s public website.

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TCM providers can reach out to their Provider Network Contract Manager, TCM Oversight Specialist or a 1915(i) subject matter expert by emailing 1915i@vayahealth.com for help completing the member’s care plan/ISP.

In addition to the 1915(i) resources listed above, plan-based care managers have access to a job aid on completing a member’s care plan in Vaya’s administrative health record system.

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Complete instructions for submitting a service authorization request (SAR) are available on the Prior Authorization webpage of Vaya’s Provider Central website. 
Additional information is available on the Resources webpage for providers.

Plan-based care managers have access to a job aid on how to complete a SAR in Vaya’s administrative health record system, as well as the resources listed above.

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TCM provider entities and care managers received 1915(i) service authorization codes in a memo sent in the Oct. 31, 2023, Vaya Provider Communication Bulletin.

This information is also available on the Authorization Guidelines webpage of Vaya’s Provider Central website.

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Provider-based care managers can check the status of a 1915(i) SAR in the Vaya Provider Portal.

Vaya’s Resources webpage includes information on accessing and navigating the portal.

Care managers with additional questions can email UM@vayahealth.com for information.

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Providers can email 1915i@vayahealth.com or call Vaya’s Provider Support Service Line at 1-866-990-9712 to inquire about a member’s care manager.