SAR Process
Provider Portal Prior Authorization Process Update
Effective June 1, 2023, providers will use the Vaya Provider Portal to submit authorization requests and to view authorization history. Providers who have been submitting requests and admission notifications in April and May (using a non-standard fax process) must begin submitting requests in the portal at this time. Detailed guidance is provided in the Provider Communication Bulletin 2022-23, Issue 56.
Providers are responsible for requesting service authorization, supplying required documentation, and demonstrating medical necessity. To request prior authorization, submit a Service Authorization Request (SAR) through Vaya Health’s Provider Portal.
If you do not have portal access or have difficulty submitting online, download the Service Authorization Request (Paper SAR) form. Scan and send the completed form via e-fax to Vaya:
- Outpatient behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services: 828-398-0571
- Inpatient behavioral health, I/DD, and TBI services: 828-348-4141
It is your responsibility to maintain documentation showing the date the paper SAR was submitted.
For assistance with authorization requests, contact Vaya’s Utilization Management (UM) Team at 1-800-893-6246, ext. 1513, or email UM@vayahealth.com. For help using the Vaya Provider Portal, visit our Learn Portal or call our Provider Support Service Line at 1-866-990-9712.
How do I complete and submit a SAR
A SAR must be submitted for each service requiring authorization. Please note:
- Except for requests based on retrospective Medicaid eligibility, all SARs must have a service start date that is on or after the date of SAR submission.
- Providers must include the name of the individual who is providing the service or who is most knowledgeable about the case, along with that person’s telephone number, in the appropriate field in the SAR.
When do I submit a SAR?
- Initial requests: SARs must be submitted at least 14 days (but no more than 30 days) prior to the requested start date of services, except for crisis, inpatient, or other expedited requests.
- Continuing requests: SARs must be submitted at least 14 days before the end of the prior authorization, except for crisis, inpatient, or other expedited requests. To avoid a gap in authorization or payment, it is your responsibility to submit a SAR for each subsequent service authorization request prior to the expiration of the current authorization and to conduct a clinical review of the individual’s ongoing need for services.
- Crisis and inpatient requests:
- Initial authorization requests: please refer to our Authorization Guidelines
- Continued authorization requests for inpatient and facility-based crisis services: the request and supporting documentation must be submitted to Vaya 24 hours prior to the lapse of the current authorization, unless the renewal date falls on a weekend or official Vaya holiday, when the request may be submitted the next business day for retrospective review.
- Expedited requests: If you believe that taking the time for a standard review could seriously jeopardize the member’s life or health or ability to attain, maintain, or regain maximum function, you may request expedited processing of the request in the electronic SAR. For paper SARs, note the request to expedite in the “Reason for admission/continued service or other comments/justification” field. The request must include clinical justification of the risk of harm.
Retrospective authorization
All authorization requests (prospective, continuing, and retrospective) are submitted electronically via the Vaya Provider Portal. If your organization does not have access to the portal, you may submit the Service Authorization Request (Paper SAR), a print screen from NCTracks that shows the Medicaid eligibility determination date, and only the necessary information from the medical record to fully justify the request to Vaya. Requests must be submitted within 90 days of the eligibility determination.
Specialized prior authorization requests
Inpatient psychiatric unit
Complete and include the following documentation with the SAR:
- Initial authorization: Regional Referral Form
- Continued authorization: Inpatient Concurrent Review Form
Alcohol and Drug Abuse Treatment Center (ADATC)
For ADATC detox or rehabilitation services, fax a completed Regional Referral Form to 828-348-4141 and include a clinical assessment.
State Psychiatric Hospital
Fax a completed Regional Referral Form and assessment to Vaya’s Member and Recipient Services Department at 1-877-917-9887. Follow the same process for individuals referred to a State Psychiatric Hospital who are diagnosed with (or with a suspected diagnosis of) I/DD and a co-occurring mental health disorder.
Child and adolescent residential placement
Submit a completed Universal Child Residential Placement Referral Form. This form is designed to help referring agencies or individuals streamline discharge planning and eliminate the time and redundancy associated with multiple agency-specific applications. Use of this form does not, and should not be construed to, guarantee authorization of residential or other treatment by Vaya. Responsibility for appropriate discharge from inpatient facilities remains with the discharging provider.