All requests for network enrollment by a hospital/health system for inpatient and/or basic outpatient services must be sent to Vaya Health using the Hospital Data Form.
Hospital Data Form (excel) Updated 05/2019
This form also allows hospitals to register or remove licensed practitioners. If you want to add enhanced outpatient services to your contract at a new or existing site, see our Provider Enrollment page for more information.
To decrease the administrative burden on hospitals directly enrolled with NC Medicaid, we are permitted (but not required) to accept and rely upon NC Medicaid’s credentialing of North Carolina-licensed hospitals. This may include all facilities and sites affiliated with the hospital seeking to be credentialed, to the extent such facilities and sites are enrolled with NC Medicaid and affiliated with the hospital in NCTracks.
Any required information not submitted to or verified by NC Medicaid must be submitted to Vaya for verification. This includes, but is not limited to, Social Security numbers and dates of birth for all owners, directors, members of the Board of Directors and managing employees.
Federal statutory law and regulations expressly prohibit us from making any payment for Medicaid services to anyone other than the contracted provider of services, except in certain limited circumstances.