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.

Authorization Guidelines 

Acute Services Authorization Guidelines

• Medicaid 1915(b) and Non-Medicaid Authorization Guidelines for Acute Services (04/18/23)

Medicaid 1915(b) and (b)(3) Service Authorization Guidelines

• Medicaid 1915(b) Authorization Guidelines for Mental Health/Substance Use Services – Adult (04/18/23)
• Medicaid 1915(b) Authorization Guidelines for Mental Health/Substance Use Services – Child (04/18/23)
• Medicaid 1915(b)(3) Authorization Guidelines for Mental Health/Substance Use Services (04/18/23)
• Medicaid 1915(b) and (b)(3) Authorization Guidelines for Intellectual/Developmental Disabilities Services (04/18/23)

Medicaid ‘In Lieu of’ Services

• Medicaid Authorization Guidelines for ‘In-Lieu of’ Services (07/14/23)

Medicaid 1915(c) Service Authorization Guidelines

• Medicaid(c) Authorization Guidelines for Innovations Services (04/18/23)

Non-Medicaid Service Authorization Guidelines

• Non-Medicaid Authorization Guidelines for Mental Health/Substance Use Services – Adult (07/14/23)
• Non-Medicaid Authorization Guidelines for Mental Health/Substance Use Services- Child (04/18/23)
• Non-Medicaid Authorization Guidelines for Intellectual/Developmental Disabilities and Traumatic Brain Injury Services (07/14/23)