Our policy is to develop and maintain a sufficient network of high-quality service providers that meets member and community needs within available resources. Network participation means that you are listed in the Vaya Health Network Directory and are eligible for referrals from Vaya. This does not include providers serving a member under an out-of-network agreement.
You must be enrolled with NC Medicaid (as a Medicaid provider consistent with the agency’s disclosure screening and enrollment requirements) and with NCTracks before you can become a contracted provider in the Vaya network. For more information, please refer to our Provider Operations Manual page.
Vaya’s network providers are required to demonstrate cultural competency, use evidence-based and best practices, practice a commitment to care and treatment that improves member outcomes, adhere to ethical and responsible practices, robustly protect member rights, and meet Vaya’s business, operational, and network development needs. Vaya is committed to the achievement of positive outcomes for members, as well as member satisfaction. We depend on our network providers to offer high-quality services and demonstrate accountability for the well-being of Vaya members.
Pursuant to 42 CFR § 447.15 and 10A NCAC 22J. 0106, it is unlawful and an unacceptable practice to knowingly demand or collect any reimbursement from a Medicaid beneficiary, their family, or legally responsible person directly, except where permitted by law.
Behavioral Health, I/DD, and TBI Provider Network
Participation in Vaya’s closed provider network for certain behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services is a privilege, not a right. We have established a fair, impartial, objective, and consistent process for the enrollment and re-enrollment of network providers that complies with applicable federal and state laws, rules and regulations, and the requirements of our contracts with NC Medicaid.
There is no right under federal or state law for any provider to participate in the closed provider network. The only exceptions are for emergency services or when there is no network provider available to provide medically necessary covered services to a particular individual. Additional information, including Vaya’s selection and retention criteria, is included in our Provider Operations Manual page.
Access to Care
Federal regulations require Vaya to maintain a network of providers sufficient in number, mix, and geographic distribution to meet the needs of the anticipated number of Medicaid beneficiaries in our region. The North Carolina Department of Health and Human Services monitors the adequacy of our closed provider network through the annual Community Mental Health, Substance Use and Developmental Disability Services Network Adequacy and Accessibility Analysis, also known as the Gaps Analysis. The Gaps Analysis includes objective measures, such as geo-mapping, to analyze service access and availability throughout our region, as well as input from member, family, provider, and stakeholder surveys.
Most services will be available within 30-45 miles or 30-45 minutes driving time. There is at least one walk-in center located in every county we serve. However, because of insufficient demand and economy-of-scale factors, some specialty providers may be located outside this radius, or there may be only one provider available to deliver the needed service. For closed network services, we are not required to contract with providers beyond the number necessary to meet the needs of members.