Policies
Vaya Health makes key policies of interest to network providers available online. Select a topic below to learn more.
Utilization Management (UM) Program Policy
Vaya’s UM clinicians evaluate the medical necessity of requested services and help ensure services are appropriate and effective, in line with the requirements of the North Carolina Department of Health and Human Services (NCDHHS). Our UM Program Policy describes the program’s goals, how we review and make decisions about requests for services, requirements for UM staff, the appeals process, and more.
Utilization Management Program Policy
Telehealth, Virtual Patient Communications, and Remote Patient Monitoring Policy
Innovative uses of technology in the provision of health care can help people access routine care and minimize the need for people to access care outside of their homes. This coverage policy is designed to supplement telehealth guidelines set forth in
NC Medicaid Clinical Coverage Policy (CCP) No. 1H.
Telehealth, Virtual Patient Communications, and Remote Patient Monitoring Policy
Prevention and Population Health Management Plan
Vaya takes a population-based approach to improving the overall health of the Medicaid members enrolled in our health plans. Population health management is the proactive application of strategies and interventions to a defined population of individuals across the continuum of healthcare delivery to maintain and/or improve the health of the individuals within the population while ensuring the right care, at the right setting, at the lowest cost, with the best member experience.
Prevention and Population Health Management Plan
Tobacco Cessation Plan
Vaya’s goal for all tobacco cessation initiatives and activities is to decrease tobacco use by members and recipients. Tobacco use is the top preventable cause of death among individuals with behavioral health disorders.