Authorization Guidelines

Coupled with applicable federal and state rules, regulations, clinical coverage policies and other guidance, Vaya Health 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.

 

Medicaid 1915(b) Service Authorization Guidelines

• Medicaid 1915(b) Authorization Guidelines for Adult Mental Health/Substance Use Services (03/18/21)
• Medicaid 1915(b) Authorization Guidelines for Child Mental Health/Substance Use Services (06/23/21)
• Medicaid 1915(b) Authorization Guidelines for Acute Services (06/17/21)
• Medicaid 1915(b) Authorization Guidelines for IDD Non-Innovations (11/13/19)

Medicaid 1915(b)(3) Service Authorization Guidelines

• Medicaid (b)(3) Authorization Guidelines for Adult and Child Mental Health/Substance Use (09/01/21)
• Medicaid (b)(3) Authorization Guidelines for Non-Innovations Intellectual/Developmental Disabilities Services (11/13/19)

Non-Medicaid Service Authorization Guidelines

• Non-Medicaid Authorization Guidelines for Adult Mental Health/Substance Use Services (08/23/21)
• Non-Medicaid Authorization Guidelines for Intellectual/Developmental Disabilities Services (11/13/19)
• Non-Medicaid Authorization Guidelines For Child Mental Health/Substance Use Services (08/23/21)

Authorization Guidelines Effective Jan. 1, 2022

 

Acute Services Authorization Guidelines

• Medicaid 1915(b) and Non-Medicaid Authorization Guidelines for Acute Services (06/17/21)

Medicaid 1915(b) Service Authorization Guidelines

• Medicaid 1915(b) Authorization Guidelines for Adult Mental Health/Substance Use Services (01/01/22)
• Medicaid 1915(b) Authorization Guidelines for Child Mental Health/Substance Use Services (01/01/22)
• Medicaid 1915(b) Authorization Guidelines for Non-Innovations I/DD Services (01/01/22)

Medicaid 1915(b)(3) Service Authorization Guidelines

• Medicaid(b)(3) Authorization Guidelines for Adult and Child Mental Health/Substance Use (01/01/22)
• Medicaid(b)(3) Authorization Guidelines for Non-Innovations I/DD Services (01/01/22)

Medicaid 1915(c) Service Authorization Guidelines

• Medicaid(c) Authorization Guidelines for Innovations Services (01/01/22)

Non-Medicaid Service Authorization Guidelines

• Non-Medicaid Authorization Guidelines for Adult Mental Health/Substance Use Services (01/01/22)
• Non-Medicaid Authorization Guidelines for Child Mental Health/Substance Use Services (01/01/22)
• Non-Medicaid Authorization Guidelines for I/DD Services (01/01/22)