COVID-19 Provider Hardship Form

Please note:

1. To be eligible for Vaya Health COVID-19 Provider Hardship Funding, you must be a current Vaya Health Network Provider, with an active network participation agreement, and must have provided Medicaid-funded services paid by Vaya on or after August 1, 2019.

2. As stated in the March 26, 2020 letter from Vaya CEO Brian Ingraham, initial COVID-19 Provider Hardship payments are primarily focused on supporting qualified providers of Medicaid services for shortfalls experienced in October 2020 due to the COVID-19 State of Emergency. 

– Vaya’s review will take into account your average monthly Medicaid payments, claims that have already been billed and/or paid and expected billing amounts for October 2020 services. 

– Providers must continue to make good faith efforts to continue submitting clean claims for services rendered throughout the State of Emergency.

3. Your hardship request should be for a specific dollar amount and should not be an amount that has to be calculated (e.g., $ per member per day). 

4. Hardship requests are not intended for capital or equipment purchases or investments, nor is this a format or process to seek a change to your unit reimbursement rate. 

Vaya continues to explore other methods for providing financial and other support to our network providers during this unprecedented State of Emergency. To learn more about the Provider Hardship Request Form read the memo here. 

Fill out Provider Hardship Form Below

Please fill out the below Provider Hardship Form electronically on this page. If you have questions contact provider.info@vayahealth.com.