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Provider Enrollment

Thank you for your interest in joining the Vaya Health provider network. All non-hospital providers, including prescribers and physician practices, must apply for enrollment in the Vaya Health network by submitting a completed Provider Contract Request Form. Use this form to: 

  • Request to enroll in the Vaya open network for physical health and/or closed network for behavioral health, including licensed independent practitioners (LIPs) seeking enrollment as an agency or independently (with your own contract not affiliated with an agency)
  • Behavioral health providers only: Request to add a new site
  • Behavioral health providers only: Request to add a new service to an existing contract with Vaya

For information on hospital/health system applications, please visit our Hospital Enrollment page.

Provider enrollment announcements

To request to change a site address or other address in an existing contract with Vaya, submit a completed Provider Change Form.

Provider Change Form

Provider Change Form

To request to add a new clinician to an existing agency, submit a completed Enrollment Initiation Form (EIF).

EIF Form

EIF Form

All providers must be enrolled in NCTracks to be eligible for enrollment in the Vaya provider network.

Questions? Contact Vaya’s Provider Enrollment Services Team at 1-855-432-9139 or ProviderEnrollment@vayahealth.com.

All providers must be enrolled in NCTracks to be eligible for enrollment in the Vaya provider network.

To request to change a site address or other address in an existing contract with Vaya, submit a completed Provider Change Form.

To request to add a new clinician to an existing agency, submit a completed Enrollment Initiation Form (EIF).

Questions? Contact Vaya’s Provider Enrollment Services Team at 1-855-432-9139 or ProviderEnrollment@vayahealth.com.

Network eligibility

Behavioral health

Federal law and our contract with the North Carolina Department of Health and Human Services (NCDHHS) allow us to limit participation in our closed network for providers of specialty behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services that are not available through NC Medicaid Managed Care Standard Plans. These providers are eligible for enrollment only when Vaya has identified a specific service need and must be enrolled in NCTracks. Contract renewal and re-enrollment for closed network providers are based on provider performance and other factors outlined in the selection and retention criteria in our Provider Operations Manual. Vaya operates an open network for all other behavioral health, I/DD, and TBI services.

Physical health

Vaya operates an open network for all other willing and qualified provider types, including physical health, pharmacy, Long-Term Services and Supports, vision, and Non-Emergency Medical Transportation (NEMT). Providers must be enrolled in NCTracks.

  • Vaya contracts with Modivcare as our NEMT broker. Visit the Transportation Provider section of the Modivcare website and click “Join Our Network.”
  • Vaya contracts with Navitus Health Solutions (Navitus) as our Pharmacy Benefit Manager. Contact Navitus at 608-298-5775 or ProviderRelations@navitus.com to enroll in the pharmacy network.
  • Vaya contracts with Avēsis to manage our vision benefit. Contact Avēsis at ProviderVisionRecruitment@avesis.com to enroll in the vision network.

Letter of support

The North Carolina Division of Health Service Regulation requires facilities submitting an initial license application to include a Letter of Support from the LME/MCO in the county where the facility will be located. To request a letter in writing from Vaya, submit the completed Letter of Support Request Form.

Out-of-Network agreements

Out-of-network (OON) providers are not listed in our Provider Directory and are not eligible for referrals. Vaya will not pay for non-emergency services, including hospital inpatient stays, delivered by a provider who does not have a current network provider contract or OON Agreement with Vaya.

Member-Specific OON Agreements for managed behavioral health services

Non-hospital OON providers must execute a Member-Specific OON Agreement if a member/recipient requires managed behavioral health services, including:

  • NC Innovations Waiver Services
  • Intermediate Care Facility for Individuals with Intellectual Disabilities
  • Enhanced mental health and substance use disorder services
  • Child facility-based services (e.g., Day Treatment, Residential Treatment Services)
  • State-funded (non-Medicaid) services
  • Services funded under the Transition to Community Living program

Member-specific OON Agreements cannot exceed 365 days from the requested effective date. If errors are found on a Member-Specific OON Agreement request post-requestor signature, Vaya will administratively deny the request, and the provider will be required to submit a new request. 

Hospitals and health systems with questions about OON Agreements may contact Vaya’s Utilization Management Team at 1-800-893-6246, ext. 1515, or UM@vayahealth.com.

Non-hospital OON providers must execute a Member-Specific OON Agreement if a member/ recipient requires managed behavioral health services, including:
  • NC Innovations Waiver Services
  • Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
  • Enhanced mental health and substance use disorder services
  • Child facility-based services (e.g., Day Treatment, Residential Treatment Services)
  • State-funded (non-Medicaid) services
  • Services funded under the Transition to Community Living (TCL) program
Member-specific OON Agreements cannot exceed 365 days from the requested effective date. If errors are found on a Member-Specific OON Agreement request post-requestor signature, Vaya will administratively deny the request, and the provider will be required to submit a new request.
 
Hospitals and health systems with questions about OON Agreements may contact Vaya’s Utilization Management Team at 1-800-893-6246, ext. 1515, or UM@vayahealth.com.