Provider Services
Name
Vaya Health Provider Support Service Line
Description
Get support for provider questions and technical assistance by phone from 7 a.m. to 6 p.m., Monday-Saturday, including holidays, or email us at any time.
Phone Number
1-866-990-9712
Provider Portal
Description
Submit and review authorization requests and claims, manage users, explore resources, and more.
Phone Number
Provider Support Service Line, 1‑866‑990‑9712
Prior Authorization and Notifications
Name
Utilization Management (UM) Team
Description
Submit and review service authorization requests through the Provider Portal.
For further assistance, contact our UM Team.
Phone Number
1-800-893-6246, ext. 1515 (behavioral health) or ext. 1526 (physical health)
Fax Number
828-348-4141
Member and Recipient Services / Eligibility
Name
Member and Recipient Services Department
Description
Get assistance for Vaya members and recipients and confirm eligibility information by calling the Member and Recipient Service Line, available 7 a.m. to 6 p.m., Monday-Saturday, including holidays.
Phone Number
1-800-962-9003
Web Link
providers.vayahealth.com/contact or providers.vayahealth.com/provider-portal (eligibility lookup)
Claims / Electronic Data Interchange (EDI)
Name
Claims Department
Description
Get help with claims submission/adjudication or payment issues. For further support, contact your assigned Claims Specialist or complete the Provider ServiceDesk Request Form.
Phone Number
1-800-893-6246, ext. 2455 (behavioral health) or ext. 2456 (physical health)
Provider Appeals
Name
Provider Appeals Team
Description
To file an appeal, visit our Provider Portal. Out-of-network providers without access to the portal should follow the instructions in the notice of the adverse determination to request an appeal.
claims.appeals@vayahealth.com/provider.appeals@vayahealth.com (all other appeal types)
Pharmacy Services
Name
Navitus Health Solutions
Description
Vaya works with Navitus as the Pharmacy Benefit Manager for Vaya Total Care pharmacy services.
Phone Number
Vaya Health Pharmacy Service Line, 1-800-540-6083
Fax Number
1-855-668-8553 (prior authorization requests)
Web Link
Name
Vaya Health
Description
Physician Administered Drug Program (PADP)
Phone Number
Provider Support Service Line, 1‑866‑990‑9712
Fax Number
828-398-0571 (PADP off-label requests)
Web Link
Nurse Line
Name
Vaya Health Nurse Line
Description
Assistance is available 24/7 to Vaya Tailored Plan Medicaid members who have basic questions about symptoms or medications or would like advice on when to go to their primary care provider.
Phone Number
1-800-290-1623
Web Link
Behavioral Health Crisis Line
Name
Vaya Health Behavioral Health Crisis Line
Description
Help is available 24/7 to all members, recipients, and residents of Vaya’s region
experiencing a mental health or substance use disorder crisis.
Phone Number
1-800-849-6127 (TTY/TDD 711)
Web Link
Interpreter Services
Name
Member and Recipient Services Department
Description
Callers can get language assistance through the Member and Recipient Service Line, available 7 a.m. to 6 p.m., Monday-Saturday, including holidays. Providers are required to offer interpreter services to the members/recipients they serve.
Phone Number
1-844-459-5411
Web Link
Fraud, Waste, and Abuse
Name
Vaya Health
Description
Report suspected fraud, waste, OR abuse
Phone Number
24/7 Confidential Compliance Hotline, 1-866-916-4255
ID Cards
Front
Back
Patient Care
Description
Call Vaya’s Member and Recipient Services Department for help with care needs,
available benefits and services, care management information, and more.
Phone Number
Member and Recipient Service Line, 1-800-962-9003 (TTY/TDD 711)
Web Link
Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS)
Name
Vaya Health/Evicore
Description
Vaya works with multiple DMEPOS vendors to serve Vaya Total Care members.
We work with EviCore to manage certain radiology, cardiology, DME, and specialized therapies (occupational, physical, and speech therapy).
Phone Number
Provider Support Service Line, 1-866-990-9712
Web Link
vayahealth.com/get-help/provider-search (DMEPOS vendors), evicore.com/provider
Transportation
Name
Modivcare Solutions, LLC
Description
Modivcare manages Non-Emergency Medical Transportation (NEMT) for Vaya Total Care members.
Phone Number
1-855-397-3606 (Facility Line), 1-888-621-2084 (Member Services)
Web Link
Vision
Name
Avēsis LLC
Description
Avēsis manages vision services for Vaya Total Care members.
Web Link