Hospital Information

Hospitals are essential providers in the continuum of care. Vaya Health works with hospitals to coordinate member care, ensure successful discharge planning, reduce readmittance rates and help members transition to local, community-based treatment settings.

Hospital coordination of care and discharge planning

Coordination of care and discharge planning begins at the time of the initial assessment and is an integral part of every member’s treatment plan. Please note that:

  • Hospitals must schedule treatment and discharge planning meetings for members within 24 hours of admission.
  • Hospitals must notify Vaya and the member’s Behavioral Health Clinical Home (BHCH) or other designated community behavioral health provider with at least 24 hours prior notice of the date, time and place of any treatment team or discharge planning meeting regarding a Vaya member. Hospitals must allow us to participate in the meetings.
  • Hospitals must notify Vaya and the member’s BHCH and/or the designated community behavioral health service provider at least 24 hours prior to the intended date and time of any discharge of a member from inpatient care.
  • Medicaid members should not be discharged with prescriptions for medication that are not covered by NC Medicaid.
  • Once the discharge date is determined, you must schedule a follow-up appointment by calling Vaya Member Services at 1-800-849-6127.
  • The follow-up appointment must be scheduled to occur within five days of discharge.

Hospital reimbursement

We reimburse contracted hospitals that provide covered, medically necessary inpatient and/or outpatient psychiatric care or medical detoxification/substance use treatment across North Carolina and in neighboring states. We also reimburse providers for covered Medicaid emergency and crisis stabilization services. For more information about covered services, please refer to the Mixed Services Payment ProtocolMedicaid Covered Diagnoses and Medicaid Covered Diagnoses: Special Populations.

Network hospital process

If you are contracted as a network provider for inpatient, enhanced and/or outpatient services, visit our Authorization Guidelines page for information on how to submit requests for services.

You must notify Vaya of any inpatient psychiatric admission of a Vaya member within 48 hours of admission. While you are granted a short “pass-through” period, we encourage you to submit the Service Authorization Request (SAR) and the Regional Referral Form within the Provider Portal within 48 hours of admission. We reserve the right to deny authorization and reimbursement of the initial pass-through period if you fail to notify us of the individual’s admission within the 48-hour timeframe. Failure to submit timely SARs may result in denial of reimbursement for non-covered service days.

Criterion 5

If all criteria for a continued acute stay in an inpatient psychiatric facility as specified in 10A NCAC 25C .0302 are not met for beneficiaries age 17 and younger, Vaya may authorize continued stay in an inpatient psychiatric facility at a post-acute level of care to be paid at an established residential rate if the facility and program services are appropriate for the member’s treatment needs and provided that all of Criterion 5 conditions are met.

Inpatient out-of-network process

If you are not a contracted provider or delivering emergency or post-stabilization crisis services to members, you must enter into an out-of-network (OON) agreement to be reimbursed for medically necessary covered services. Contact Vaya’s Utilization Management (UM) Department at 1-800-893-6246, ext. 1513 to initiate the process.