Claims

We utilize AlphaMCS software for core NC Medicaid Waiver and State-Funded (IPRS) operations. This includes authorization entry, claims submission, and review of provider profile information.

The Claims Team researches claim submissions on a daily basis. Claims are available for research the following day after a submission. Specialists work with other staff to correct any errors in our system that might have caused a denial. These denials are then re-worked internally with no action required by the provider. The Claims Staff proactively contacts providers to alert them of denials that need to be corrected and resubmitted by the provider.

pdf-1 Claims Research for Providers

Questions? 

Email: Claims@VayaHealth.com
Call: 828-225-2785 , ext. 2455

The Claims Team can answer the following questions:

  • Why was my claim denied?
  • What does this denial code mean?
  • Why is the claim denying due to no authorization when I have an authorization?
  • Why is the claim denying due to authorized units exceeded?
  • Why is the claim denying due to a combination of No Coverage for Patient/Service/Provider?
  • How do I replace a claim?
  • How do I revert (void) a claim?
  • How many days do I have to resubmit a denied claim?
  • I submitted an incorrect unit amount on my claim—how do I fix this?
  • How can I appeal a denial?
  • Where can I find my Remittance Advice (RA) in Alpha?
  • How can I understand credit memos on my Remittance Advice?
  • Why was my claim only partially paid?
  • A consumer has Medicaid in NCTracks. Why are their claims denying for no coverage or no enrollment on date of service?

 

Click here for the Claims Corner Bulletin Archive.

Looking for the Vaya Health Checkwrite Schedule? Visit the Provider Resources section of our website. 

Call 1-800-849-6127 toll free 24/7 to obtain services and support for mental health, developmental disabilities and substance abuse. Members can request materials in Spanish or English.

Llamar al número gratuito 1-800-849-6127 24/7 para obtener servicios y apoyo a la salud mental, discapacidades de desarrollo y abuso de sustancias. Los miembros pueden solicitar materiales en español o Inglés.