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 (b)(3) Services Authorization Guidelines

Medicaid 1915(i) Services Authorization Guidelines

Medicaid ‘In Lieu of’ Services Authorization Guidelines

Medicaid 1915(c) Services Authorization Guidelines

Non-Medicaid Services Authorization Guidelines

Vaya Total Care Physical Health Services Authorization Guidelines