Important Announcements
Provider Resources
Forms and Resources
Get forms and tools needed to do business with us and support Vaya members and recipients.
View FormsProvider Communication Bulletins
Stay on top of the latest news, updates, and announcements for Vaya network providers.
Communication Bulletins ArchiveProvider Touchpoint
Catch up on the latest informational webinars for Vaya network providers.
Provider TouchpointProvider Operations Manual
Reference our Provider Operations Manual for network participation requirements.
Provider Operations Manual
Claims
Submit claims and review claims status through our secure Provider Portal. Vaya also accepts claims submissions via secure file transfer protocol (SFTP), electronic data interchange (EDI) files, or paper submission (in limited circumstances only).
ClaimsPrior Authorization
Providers are responsible for requesting service authorization, supplying required documentation, and demonstrating medical necessity. To request prior authorization, submit a service authorization request (SAR) through our Provider Portal. If you do not have access to the portal, visit our Prior Authorization webpage for alternate submission methods.
Prior Authorization
Authorization Guidelines
Familiarize yourself with the authorization guidelines for services covered under Vaya’s Medicaid and State-funded benefit plans. Authorization decisions are based on medical necessity and made in accordance with individual needs, Medicaid waiver and clinical coverage policy requirements, federal regulations, clinical practice guidelines, and applicable federal and state rules and regulations. Not all services require prior authorization.
Authorization GuidelinesWhole-Person Care in North Carolina
We know many things can affect health – from medical conditions or mental health concerns to housing, food, and transportation. Our care managers work with physical and behavioral health care providers and link our members and recipients to community resources to help them get or stay well. Learn more about Vaya Total Care, our approach to whole-person care.
Provider Support Service Line:
1-866-990-9712
Pharmacy Service Line:
1-800-540-6083
7 a.m. to 6 p.m., Monday – Saturday, including holidays
Subscribe to our weekly Provider Communication Bulletins for the latest announcements.
Call our 24-hour Confidential Compliance hotline.
