All network providers are reimbursed at the lesser of the Vaya Health published rates for the service being provided or your usual and customary charge for the services, unless otherwise stated in your contract or identified in AlphaMCS. In general, Vaya follows the NC Medicaid fee schedule for Medicaid services.
Rate changes will be announced at least 30 days in advance unless they result from a change imposed by the General Assembly, NC Medicaid or the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS). You can submit claims for more than the published rates, but only the published or contracted rate will be paid.
If you submit a claim for less than the published or contracted rate, the lower rate will be paid. It is the provider’s responsibility to monitor the publishing of rates and to make the necessary changes to their billing systems.
Vaya adheres to the standardized LME/MCO checkwrite schedule, which is based on a 5 p.m. Tuesday cutoff. Claims received before this cutoff date will be paid the following week according to the checkwrite schedule. The schedule accommodates for state and federal holidays occurring during the work week.