Coupled with applicable federal and state rules, regulations, clinical coverage policies, and other guidance, Vaya Partners uses the authorization guidelines in making decisions about requests for authorization. You and your staff must be familiar with them as they apply to the conditions and diagnoses you treat. For services that require authorization, you may not seek payment for amounts or units that exceed those approved for authorization by Vaya Partners.
Vaya Partners Authorization Guidelines
- Prior Authorization Look-up Tool and Guidelines – Behavioral Health (.xlsx)
- Prior Authorization Look-up Tool and Guidelines – Physical Health
- Vaya Partners follows current posted NC Medicaid clinical coverage policies, available on the Program Specific Clinical Coverage Policies page of the NC Department of Health and Human Services website.
- Imaging Services: Note that Vaya Partners Medicaid Clinical Coverage Policy 1K-7 Prior Approval for Imaging Services also applies.
- Physician Administered Drug Program Catalog
Mental Health Parity Resources
- Mental Health Parity FAQ 1
Research-Based Behavioral Health Treatment Guidance
- Research-Based Behavioral Health Treatment Guidance
Specialized Consultation Services Guidance
- Specialized Consultation Services Guidance