Sometimes Vaya Partners may decide to deny, suspend, reduce, or terminate a request your provider makes for you for State-funded services covered by our plan. You will receive a letter from Vaya Partners notifying you of any decision to deny, suspend, reduce, or terminate a service request your provider makes. The letter will include information about the reason for the decision and any available options while the appeal is under review.
State-funded services recipients have the right to appeal decisions to deny, suspend, reduce, or terminate their services. Vaya Partners must receive your appeal in writing within 15 working days from the date of the notification letter.
What can I expect during the appeals process?
When you ask for an appeal, Vaya Partners has seven business days to give you an answer. You can ask a family member, a friend, your provider, or a legal representative to help you with your appeal. You or your legal guardian can ask for an appeal. You can call ACCESS Member Services at 1-888-235-4673 if you need help with your appeal request.
How can I submit an appeal?
It is easy to ask for an appeal by using one of the options below:
MAIL: Fill out and sign the Appeal Request Form in the notice you receive about our decision. Mail it, and any additional information you want us to consider, to the address listed on the form. We must receive your form no later than 15 working days after the date on the notification letter.
FAX: Fill out and sign the Appeal Request Form in the notice you receive about our decision. Fax it, and any additional information you want us to consider, to the number listed on the form. We must receive your form no later than 15 working days after the date on the notification letter.
Email: Fill out and sign the Appeal Request Form in the notice you receive about our decision. Email it, and any additional information you want us to consider, to the address listed on the form. We must receive your form no later than 15 working days after the date on the notification letter.
ONLINE: Submit the Appeal Request Form available in the Vaya Partners MemberCONNECT portal. Attach documents you want us to consider.
PHONE: Call ACCESS Member Services at 1-888-235-4673 and ask for an appeal.
IN PERSON: You may hand-deliver an appeal to Vaya Partners’ office at 901 S. New Hope Road, Gastonia, NC 28054.
Timelines for appeal decisions
Timelines for appeals
Vaya Partners will make a decision on your appeal within seven business days from the day we get your appeal request. We will mail you a letter to tell you about our decision.
Decisions for appeals
If you do not agree with our decision, you can ask for an appeal with the State Non-Medicaid Appeals Panel. The panel is part of the North Carolina Department of Health and Human Services (NCDHHS) Division of Mental Health, Developmental Disabilities, and Substance Use Services.
Your decision letter from Vaya Partners will include a State Non-Medicaid Appeal Request Form. To ask for an appeal with the State Non-Medicaid Appeals Panel, mail or fax the completed form to:
- MAIL: Division of MHDDSUS Hearing Office, c/o Customer Service and Community Rights, Mail Service Center 3001, Raleigh, NC 27699-3009
- FAX: 984-777-9264
The request for an NCDHHS-level appeal must be received within 11 calendar days from the date on the letter from Vaya Partners.
State Non-Medicaid appeals panel
The State Non-Medicaid Appeals Panel will review your request and will issue its findings and recommended decisions. Vaya Partners will issue a final written decision on your request that considers the State Non-Medicaid Appeals Panel’s findings. We make a final decision within 10 days of receiving the panel’s findings.
Continuation of services during an appeal
Sometimes Vaya Partners’ decision reduces or stops a healthcare service you are already getting. You can ask to continue this service without changes until your appeal is finished. Vaya Partners is not required to continue this service.
To request to continue services during your appeal, call Vaya Partners’ Member Appeals Team at 1-800-893-6246, ext. 1400.
