Provider Enrollment

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

All other 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.

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).

Network Eligibility

  • Behavioral health network: 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 behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) providers. 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 behavioral health providers are based on provider performance and other factors outlined in the selection and retention criteria in our Provider Operations Manual.
  • Physical health network: Vaya operates an open network for all other willing and qualified provider types, including physical health, pharmacy, long-term services and supports (LTSS), vision, and non-emergency medical transportation (NEMT). Providers must be enrolled in NCTracks.
    • Vaya contracts with Modivcare as our NEMT broker. Please contact Modivcare at to enroll in the Modivcare NEMT network.
    • Vaya contracts with Navitus Health Solutions (Navitus) as our pharmacy benefit manager (PBM). The Navitus contracting period will begin soon. Please revisit this page soon for additional information.
    • Vaya contracts with Avēsis to manage our vision benefit. Please contact Avēsis at to enroll in the vision network.

Letter of Support

The NC 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

Vaya contracts with out-of-network (OON) providers only if we cannot meet the need for geographically accessible, appropriate, or timely services for a specific member or recipient. 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. After the first 90 days of Tailored Plan operations, Vaya may only pay OON providers at 90% of the in-network rate.

To request an OON agreement to provide care to a Vaya member or recipient who is unable to be served by a network provider, submit a completed Out-of-Network Agreement Request. For hospitals/health systems, call Vaya’s Utilization Management team 1-800-893-6246, ext. 1513.

Please note that an OON agreement cannot exceed 365 days from the requested effective date. If errors are found on an OON agreement request post-requestor signature, the request will be administratively declined, and a new request will need to be submitted.


For more information, contact Vaya’s Provider Enrollment Services team at 1-855-432-9139 or