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Vaya Partners will implement prior authorization flexibilities beginning on Oct. 1, 2026.

Authorization guidelines are available on the Vaya Partners website, the Partners website, and the Vaya website.

  • The following services delivered after Sept. 30, 2026, through Dec. 29, 2026, will not require prior authorization or admission notification:
    • Physical Health Services
      • Exception: Services that have Electronic Visit Verification (EVV) requirements [see section below for information about State Plan Personal Care Services (PCS)]
    • Mental Health/Substance Use Disorder services
      • Exception: 1915(i) Services
      • Psychiatric Residential Treatment Facility (PRTF)
    • The following services will not require prior authorization, but providers must send an admission notification via ProviderCONNECT using the authorization request form.
      • Behavioral Health Inpatient Services
      • Physical Health Inpatient Services
    • The following levels of care will continue to follow the posted authorization guidelines and standard Vaya Partners UM procedures:
      • Innovations – All requests will continue to require prior approval to allow for Individual Support Plan (ISP)/Care Plan approval and updates as needed:
    • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
    • Research Based-Behavioral Health Services (RB-BHT)
    • 1915(i) Services
    • Long Term Community Supports (LTCS)
    • 1915(i) Services
    •  PRTF
  • All services are subject to post-payment review which may include a review of all required documentation included in Vaya Partner’s published authorization guidelines, as well as service delivery documentation maintained by the provider.

Please see updated authorization guidelines for questions related to specific services.

Guidance for PCS providers:

On and after Oct. 1, 2026, providers must continue to submit Requests for Independent Assessments for PCS for Vaya Partners Tailored Plan members to 828-707-9349.

Vaya Partners will schedule reassessments in accordance with NC Medicaid Clinical Coverage Policy 3L and 3L-1. Vaya Partners will extend authorizations expiring prior to a member’s reassessment to ensure continuity of care.

Who can providers contact if they have questions?

Updated: