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 ncnetwork@modivcare.com 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 ProviderVisionRecruitment@avesis.com 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.

Questions?

For more information, contact Vaya’s Provider Enrollment Services team at 1-855-432-9139 or ProviderEnrollment@vayahealth.com.