Provider Services
Name
Vaya Partners ACCESS Provider Services
Description
Get support for provider questions and technical assistance by phone from 7 a.m. to 6 p.m., Monday-Saturday, including holidays, or email us at any time.
Phone Number
ProviderCONNECT Portal
Description
Submit and review authorization requests and claims, manage users, explore resources, and more.
Phone Number
ACCESS Provider Services, 1‑866‑990‑9712
Web Link
Prior Authorization and Notifications
Name
Utilization Management (UM) Team
Description
Submit and review service authorization requests through the Provider Portal.
For further assistance, contact our UM Team.
Phone Number
1-800-893-6246, ext. 1515 (behavioral health) or ext. 1526 (physical health)
Web Link
providers.vayapartners.org/prior-authorization/
Member Services / Eligibility
Name
Member Services Department
Description
Get assistance for Vaya Partners members and recipients and confirm eligibility information by calling the ACCESS Member Services, available 7 a.m. to 6 p.m., Monday-Saturday, including holidays.
Phone Number
Web Link
providers.vayapartners.org/contact or
providers.vayapartners.org/portal (eligibility lookup)
Claims / Electronic Data Interchange (EDI)
Name
Claims Department
Description
Get help with claims submission/adjudication or payment issues. For further support, contact your assigned Claims Specialist or complete the Provider Service Desk Request Form.
Phone Number
1-800-893-6246, ext. 2455 (behavioral health) or ext. 2456 (physical health)
Provider Appeals
Name
Provider Appeals Team
Description
To file an appeal, visit our ProviderCONNECT Portal. Out-of-network providers without access to the portal should follow the instructions in the notice of the adverse determination to request an appeal.
claims.appeals@vayapartners.org/provider.appeals@vayapartners.org (all other appeal types)
Pharmacy Services
Name
Navitus Health Solutions
Description
Vaya Partners works with Navitus as the Pharmacy Benefit Manager for Tailored Plan pharmacy services.
Phone Number
Vaya Partners Pharmacy Service Line, 1-800-540-6083
Fax Number
1-855-668-8553 (prior authorization requests)
Web Link
Name
Vaya Partners
Description
Physician Administered Drug Program (PADP)
Phone Number
ACCESS Provider Services, 1‑866‑990‑9712
Web Link
Nurse Advice Line
Name
Vaya Partners Nurse Advice Line
Description
Assistance is available 24/7 to Vaya Partners Tailored Plan Medicaid members who have basic questions about symptoms or medications or would like advice on when to go to their primary care provider.
Phone Number
Web Link
Behavioral Health Crisis Line
Name
Vaya Partners Behavioral Health Crisis Line
Description
Help is available 24/7 to all members and residents of Vaya Partners’ region
experiencing a mental health or substance use disorder crisis.
Phone Number
1-800-849-6127 (TTY/TDD 711)
Interpreter Services
Name
Member Services Department
Description
Callers can get language assistance through the Access Member Services Line, available 7 a.m. to 6 p.m., Monday-Saturday, including holidays. Providers are required to offer interpreter services to the members they serve.
Phone Number
Fraud, Waste, and Abuse
Name
Vaya Partners
Description
Report suspected fraud, waste, or abuse
Phone Number
24/7 Confidential Compliance Hotline, 1-866-916-4255
ID Cards
Front
Back
Patient Care
Description
Call Vaya Partners’ Member Services Department for help with care needs, available benefits and services, care management information, and more.
Phone Number
ACCESS Member Services, 1-888-235-4673 (TTY/TDD 711)
Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS)
Name
Vaya Partners/Evicore
Description
Vaya Partners works with multiple DMEPOS vendors to serve Tailored Plan Medicaid members. We work with EviCore to manage certain radiology, cardiology, DME, and specialized therapies (occupational, physical, and speech therapy).
Phone Number
ACCESS Provider Services, 1-866-990-9712
Web Link
(DMEPOS vendors), evicore.com/provider
Transportation
Name
Modivcare Solutions, LLC
Description
Modivcare manages Non-Emergency Medical Transportation (NEMT) for Tailored Plan Medicaid members.
Phone Number
1-855-397-3606 (Facility Line), 1-888-621-2084 (Member Services)
Web Link
Vision
Name
Avēsis LLC
Description
Avēsis manages vision services for Tailored Plan Medicaid members.
Web Link