Welcome Rockingham County Providers

Vaya is excited to welcome Rockingham County to our service region. We are glad to be working with you to deliver high-quality health care services to the members and recipients we serve. We want to make this change as seamless as possible for members and families, providers, the county, and other stakeholders. We value your efforts to provide care and ensure that Vaya members and recipients – your patients – have a positive healthcare experience.

We created this webpage to help you and your staff get to know us. The information below directs you to essential resources and information for doing business with Vaya. Additional resources and information will be posted here as they become available.

If you need help, our Provider Support Service Line is available to answer questions by phone at 1-866-990-9712 (Monday – Saturday, 7 a.m. – 6 p.m.) or via provider.info@vayahealth.com.


Questions and Answers

In late 2023, NCDHHS issued a directive to realign Rockingham County from Sandhills Center to Vaya Health’s region beginning Feb. 1, 2024. Vaya now manages behavioral health and I/DD services and supports for Medicaid beneficiaries and state-funded recipients in Rockingham County.

Below are answers to support providers transitioning from the Sandhills provider network.

Who is Vaya Health?

Vaya Health is a Local Management Entity/Managed Care Organization (LME/MCO) that manages services for people with behavioral health (mental health and substance use), I/DD, and TBI in certain North Carolina counties. Beginning in 2024, Vaya Health will also manage physical health and pharmacy services for Medicaid.

Our partnerships with providers enable us to meet the needs of those we serve. Through collaboration, we move toward the vision of a community-based, provider-driven approach that will advance whole-person care and create better health outcomes. Vaya’s roots in North Carolina go back 50 years. Alongside Vaya Health members, recipients, providers, and community stakeholders, we are moving forward together toward a healthier North Carolina.

Will providers automatically be enrolled in the Vaya network if they are currently enrolled with Sandhills?

Vaya offered all contracted Sandhills providers in good standing a contract with Vaya. We have been actively building a statewide provider network and expect most Sandhills providers currently have a contract with us. If you have not executed a contract with us, we hope you will consider joining the Vaya provider network to help ensure continuity of care for Rockingham County members. Please email us at provider.info@vayahealth.com and we will expedite your contract request.

We have contracts with both Sandhills and Vaya. Do we need to terminate our Sandhills contract effective on the date of consolidation?

No. Termination of your contract with Sandhills is not necessary. Providers began providing services under their contract with Vaya effective Feb. 1, the date that the North Carolina Department of Health and Human Services (NCDHHS) reassigned members/recipients to Vaya. Any sites or services in your Sandhills contract was automatically added to your Vaya contract, and no additional steps need to be taken.

Will Vaya accept the Sandhills contracted rates?

We use the Vaya fee schedule. However, even though NCDHHS has not provided Vaya with funding to support paying providers the Sandhills contracted rates, we are honoring any Sandhills enhanced member or provider-specific rates for Rockingham County members through June 30, 2024. We will evaluate our ability to continue paying those enhanced rates based on funding received from NCDHHS.

Can we submit requests to contract with Vaya for additional services beyond the services contracted with Sandhills?

Yes, providers always have the option to request additional services be added to their contract through the Provider Request to Contract process.

For more information, visit our Provider Enrollment webpage.

Will Vaya honor Sandhills authorizations for services that are approved annually?

We are honoring all existing authorizations issued by Sandhills through the end of the authorization period, including services authorized annually through the Innovations plan of care process. If you have questions or concerns about an authorization, our Utilization Management Team can work directly with you to best support the members and recipients we serve.

We currently have an out-of-network (OON) agreement with Sandhills. Will we be able to continue serving the members/recipients in our care?

Yes. If you are in good standing, we will first work with you to enter into a full network contract with Vaya.

If that is not possible, we will offer you the opportunity to sign an OON with Vaya for the remainder of the episode of service.

  • Medicaid providers – including but not limited to certified Tailored Care Management (TCM) providers – can request an OON agreement within 180 days from the date of service.
  • State-funded providers can request an OON agreement through the end of SFY 2024, no later than June 30, 2024.

To initiate an OON agreement, providers should follow the instructions on our Provider Enrollment webpage.

What are Vaya’s UM guidelines?

Our current Authorization Guidelines are available on our Provider Central website.

How does Vaya reimburse providers for State-funded services?

We use a capitated, performance-based contract for some services, but not all. We also have fee-for-service arrangements for some State-funded services.

We are honoring your existing State-funded services payment arrangement with Sandhills as outlined in your Sandhills contract. If you think we need to change the arrangement you have with Sandhills, we are open to that conversation. Our goal is to ensure continuity of care for Vaya State-funded recipients to make sure services are available, robust, and high quality for the counties we serve.

Will Vaya continue all State funded contracts in Rockingham County?

Our goal would be to continue all existing State-funded services arrangements in Rockingham County. However, we have not yet received final information from NCDHHS about how they intend to allocate State and/or federal funding from Sandhills to Vaya. Once we receive the approved allocation, we will be in a better position to determine which State-funded services contracts can be funded.

How will 1915(i) and State-funded services be handled?

We contracted with Rockingham County providers for all services that were in their contract with Sandhills. If 1915(i) and State-funded services are not currently in your contract, you can request to add them.

For more information, visit our Provider Enrollment webpage.

Do any Vaya services not require prior authorization, or do any of them have pass-throughs?

Yes, Vaya has services that do not require prior authorization.

Learn more on our Authorization Guidelines webpage.

Does Vaya require submission of a discharge service authorization request (SAR) when a service ends?

Behavioral health services do not require submission of a discharge SAR.

Will behavioral health providers continue to provide trauma-focused therapy within the Vaya network? If so, what will we be required to do as a clinic?

Yes. We support trauma-focused therapies delivered by network providers. Your Vaya contract includes the services that were in your Sandhills contract.

How will Vaya handle non-UCR funding previously handled by Sandhills?

Vaya worked closely with Sandhills to identify any providers with contracts that include non-UCR funding. Once we receive our allocated portion of State and/or federal funding from NCDHHS, we will work with providers to add those services to their Vaya contract.

To inquire about funding in a county that will not transition to Vaya, please contact the LME/MCO serving that county.

Under the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan, will the care manager work with the community navigator, or will the Community Navigator service be eliminated?

Under the Tailored Plan, Community Navigator services are available only to NC Innovations Waiver participants who receive services under the Employer of Record (EOR) model.

Will we need to resubmit Relative as Direct Support Employee (RADSE) prior approvals once realignment occurs?

Vaya is honoring prior approvals by Sandhills for RADSE-provided services through the end of the member’s current plan year, or when the RADSE approval ends, whichever date is first.

When and where do we begin submitting claims to Vaya?

Claims for services rendered on or after Feb. 1, 2024 to Vaya members and recipients must be submitted to Vaya through our Provider Portal or a HIPAA-compliant 837 EDI file. Detailed instructions for claims submission can be found on our Claims Submission webpage.

As a flexibility for Rockingham County providers only, Vaya is honoring paper claims for 90 days after the Feb. 1, 2024, transition and will outreach the provider to sign up for the Provider Portal or encourage EDI submission.

What timely filing flexibilities do providers have on or after Feb. 1, 2024?

To support a smooth transition, Vaya is allowing providers to submit both Medicaid and State Plan claims up to 180 days from the date of service/ date of discharge (for inpatient/ skilled nursing facilities only). Vaya reviews clean claims submitted after the 180-day deadline for Rockingham County members on a case-by-case basis.

Who will resolve claims denials that were made by Sandhills prior to realignment?

Sandhills will manage all claims activity (including denials) that occurs prior to realignment on Feb. 1, 2024.

What is Vaya’s process for recoupment of funds?

Our process depends on the situation and the reason for recoupment. In general, we first notify the provider that we have identified a potential overpayment and offer them the opportunity to dispute the amount owed through our appeal process. If the overpayment is upheld, the provider can pay the amount owed directly, enter into a settlement agreement, or Vaya can recoup the funds against future claims over time. As outlined in your contract with Vaya, our Claims Department reserves the right to automatically adjust claims and recoup payments based on errors found through the claims adjudication process.

How can I get help with claims issues?

For claims specific to Vaya, call our Claims Department at 1-800-893-6246, ext. 2455, or email claims@vayahealth.com. Providers should call Sandhills if they have issues related to claims processed by Sandhills

How do I accept pending placements in the HHAeXchange portal?

Vaya adds members who are placed with a network provider from whom they have not previously received services to that provider’s Pending Placement Queue in HHAeXchange.

To ensure all provider staff can accept pending placements in HHAeXchange, the account administrator must confirm that all staff accounts have a check in the box next to “accept unspecified office placements.” For instructions on managing members on your Pending Placement Queue within HHAeXchange, refer to the Accepting Placements job aid in the Help section of the HHAeXchange portal.

Follow the steps below to search Vaya’s Provider Portal for a member on your HHAeXchange Pending Placement Queue:

  • Select the Authorizations tab.
  • Search by NPI number and date range.
  • View the list of authorizations that displays.
  • Select the funnel image next to “Authorization ID” to filter the list by the ID associated with the pending placement.

What is Vaya’s provider enrollment process?

Vaya uses data from the Provider Eligibility File (PEF) that we receive from NCTracks to enroll providers into our network. We import any sites, services, and practitioner affiliations you have registered with NCTracks. Vaya staff will work with your organization to add any additional enhanced services or provider-specific rates to your contract.

What can be done in the Vaya Provider Portal?

Vaya’s Provider Portal is a complete resource for service authorization and claims submission/tracking needs. The portal also provides additional resources to help you do business with Vaya.

How do we get access to the Provider Portal?

If you are not currently a Vaya network provider, you will be able to designate a systems access administrator (SAA) from your organization as part of the contracting process. We will create a user profile for your SAA in the portal, and your SAA will create and manage user profiles for all portal users at your organization.

If your organization is currently contracted with Vaya, but you don’t know who your organization’s SAA is, you can email us at providerportal.saa@vayahealth.com or contact our service desk at 1-800- 893-6246, ext. 1500.

How do I learn to use the Provider Portal?

We have made job aids and recorded trainings available on our Resources webpage. We will offer additional training and Q&A opportunities for new providers who joined our network from Sandhills.

The weekly Provider Communication Bulletin email is a great way to know when trainings are announced. Sign up to receive the Provider Communication Bulletin on our website.

Who should our electronic health record (EHR) company contact to prepare our systems to bill Vaya?

Information regarding the use of EHR vendors and clearinghouses for claims submission is available on our Claims webpage.

Provider Portal and Crush FTP (for 837 submission) job aids are available on our Resources webpage.

Will technical support be available to resolve any portal issues?

Yes. We provide multiple levels of support depending on the type of issue you are having. You may call our Service Desk at 1-800-893-6246, ext. 1500, or email servicedesk@vayahealth.com. We will triage your issue and assign it to the Vaya team that is best able to help you.

How will Vaya staff interact with providers?

At Vaya, we believe that providers are the key to our success, and we focus on providing support and technical assistance to help providers navigate our system. We value active engagement with our provider network and are committed to offering support and resources during the transition.

We announce virtual provider support sessions in our weekly Provider Communication Bulletin email and during our biweekly Provider Touchpoint webinars. The Provider Touchpoint webinars are also announced in the weekly Provider Communication Bulletin. Our Provider Support Service Line is available at 1-866-990-9712, 7 a.m. – 6 p.m., Monday – Saturday, including holidays. You also may email provider.info@vayahealth.com.

How will Vaya keep me informed?

The Vaya Health Provider Operations Manual outlines network requirements and provides helpful information. View or download the manual from our Provider Manual webpage.

Weekly Provider Communication Bulletin emails provide the information you need to do business with Vaya. You can sign up online and view past bulletins on our Communication Bulletins Archive webpage.

Vaya hosts Provider Touchpoint live webinars every two weeks. Our webinars provide important updates and an opportunity for attendees to ask questions. We encourage all network providers to attend. Recordings and slide decks from previous Provider Touchpoint webinars are available here on our Provider Touchpoint webpage.

Our Provider Advisory Council (PAC) represents all provider groups. We encourage all contracted providers to participate in the monthly virtual meetings. Providers are also encouraged to join one or more of the PAC subcommittees. More information about the PAC is available on our Provider Advisory Council webpage or by emailing provideradvisorycouncil@vayahealth.com.

Will Sandhills providers be connected to a Vaya provider network contract manager? If so, when?

Yes. Your provider network contract manager is your first contact and advocate at Vaya. As part of your Welcome Packet when you contract with Vaya, we connect you to your provider network contract manager. If you are already contracted with Vaya and do not know who your provider network contract manager is, email provider.info@vayahealth.com or call our Provider Support Service Line at 1-866-990-9712. Provider network contract managers may change as we continue to grow our provider network. If a change is necessary, we will notify you.

Will Vaya staff communicate orally with providers to resolve issues, or will providers be required to communicate through email?

We believe in delivering excellent customer service to network providers through the form of communication that works best for you. Providers are not required to communicate only through email. You may always ask to speak to your provider network contract manager or call our Provider Support Service Line at 1-866-990-9712.

What are the Tailored Plan training requirements for providers in Vaya’s network?

The Vaya Learn Portal contains educational materials to meet all Tailored Plan training requirements. Vaya currently requires the following three trainings to be completed by each provider organization’s contract signatory or designee:

  • Medicaid Managed Care
  • Fraud, Waste, & Abuse
  • Provider Orientation

While we accept completion of these trainings with Sandhills, we strongly encourage you to review Vaya’s Provider Orientation training as there are differences in Vaya’s policies and procedures for providers.

For more information, visit our Provider Trainings webpage.

When will current Vaya network providers start serving members/recipients in Rockingham County?

Effective Feb. 1, 2024, you will provide services to Rockingham members/recipients under your Vaya contract. Please note: Your organization will need to ensure that any additional sites and services needed to serve Rockingham members/recipients were added to your Vaya contract. If you have questions about the sites or services in your contract, contact your Provider Network contract manager or email provider.info@vayahealth.com.

How do I contact a member or recipient’s care manager/care coordinator?

Providers can call our Provider Support Service Line is 1-866-990-9712 for assigned care manager/care coordinator contact information.

Which counties are currently in Vaya’s region?

Vaya currently serves Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rockingham, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, and Yancey counties.

Which county is transitioning to Vaya?

Rockingham County transitioned to the Vaya region on Feb. 1, 2024. Learn more about county realignments in this fact sheet from NCDHHS.

How do we know which LME/MCO serves a particular member/recipient?

Information for Medicaid beneficiaries is available in NC Tracks, our Provider Portal, and on the beneficiary’s Medicaid ID card. Rockingham County members received new Medicaid ID cards from county officials that identify Vaya as their assigned LME/MCO. Recipients of State-funded services are enrolled with the LME/MCO that serves the individual’s county of residence. Vaya worked with State-funded services providers to ensure recipients were correctly enrolled in our system.

Resources

Fact Sheet: LME/MCO Consolidation Overview and FAQs – For Providers from NCDHHS.

Sign up for Vaya’s Provider Communication Bulletin. This weekly email delivers information and resources providers need to deliver high-quality care for Vaya members and recipients. Read previous emails on Provider Central.

Provider Touchpoint live webinars: Vaya hosts a live webinar every other Friday from 11 a.m. – 12 p.m. and are open to all Vaya Health providers. The Provider Touchpoint webinars are your source for the most up-to-date information about working with Vaya. Each webinar includes a question-and-answer session with Vaya subject matter experts. Upcoming Touchpoints are announced in the weekly Provider Communication Bulletin email. Watch previously recorded Touchpoints on Provider Central.

Vaya’s Provider Operations Manual gives detailed information and technical assistance to Vaya Health network providers. The manual covers all requirements for network participation.

Provider Central Resources webpage has job aids and training videos to help providers perform functions as a Vaya Health network provider. Vaya Learn Portal is where providers can complete required and optional trainings and access course content.


Provider Support

We are offering multiple educational opportunities for providers transitioning from Sandhills to Vaya.  

Vaya Health’s biweekly Provider Touchpoint live webinar is your source for the latest information on topics that affect Vaya network providers. We encourage all network providers to attend. Registration is not required. The link to each webinar is published both the week prior to and the week of the event in the Provider Communication Bulletin.

Welcome Sandhills Provider Orientation Touchpoints

Provider Portal Trainings are being offered during the transition period to help you learn how to use our Provider Portal.

PLEASE NOTE: Pre-recorded Provider Portal trainings and job aids are currently available to you on our Provider Central Resources webpage.  

Provider Portal Trainings (Claims)

Provider Portal Trainings (Main)

Open Office Hours webinars are hosted in a drop-in format and designed to answer your specific questions about doing business with Vaya (Provider Portal and other software platforms, authorizations, claims, etc.) You are welcome to just ask your question or stay to listen to other provider’s questions. Open Office Hours sessions are staffed by a variety of Vaya subject matter experts (SMEs) who can answer your questions in real time or find the answer and get back to you quickly.

PLEASE NOTE: Because these webinars are open to all providers, PHI cannot be discussed in the general session. If your question is member/recipient-specific, one of our SMEs will assist you in a separate break out room or on a separate phone call.

Provider Open Hour Sessions


More Questions?

Call the Vaya Provider Support Service Line at 1-866-990-9712 or email provider.info@vayahealth.com.

Call the Sandhills Provider Help Desk 1-855-777-4652 or email providerhelpdesk@SandhillsCenter.org.