Provider Services
Description / Hours
Available 7 a.m. to 6 p.m., Monday – Saturday, including holidays, for providers who have general questions, need technical assistance, or would like to request to add a site or service
Phone Number
1-866-990-9712
Provider Portal
Description
Enroll, discharge, search for, and update information on recipients of State-funded services
Submit and view service authorization requests
Submit claims and review remittance advice (RA) reports
Review value-based performance reports and provider-directed documents
Issue and manage employee logins to the Provider Portal
File grievances, complaints, and appeals
Access Vaya resources (e.g., Provider Central, handbooks, delegated vendors portals)
Submit provider surveys
Access provider trainings through the Vaya Learning Lab
Access information about contacting Vaya
Phone Number
For other assistance, call our Provider Support Service Line at 1-866-990-9712 (7 a.m. to 6 p.m., Monday – Saturday).
Need help logging in or creating a new account? Contact your organization’s System Access Administrator (SAA) or review our SAA Job Aid
Prior Authorization / Notifications
Description
Service authorization requests and reviews
Phone Number
1-866-990-9712
Fax Number
828-398-0571 (General UM) 828-348-4141 (Inpatient)
Member and Recipient Services / Eligibility
Description / Hours
Available 7 a.m.to 6 p.m., Monday – Saturday, including holidays, to help Vaya members/recipients and the public with non-emergency issues and questions
Phone Number
1-800-962-9003
Claims and Enrollment / Electronic Data Interchange (EDI)
Description / Hours
Available 7 a.m. to 6 p.m., Monday – Saturday, including holidays, for providers who have general questions, need technical assistance, or would like to request to add a site or service
Web Link
Email Address
To enable Vaya to properly triage and/or expedite EDI requests, email EDI@vayahealth.com
Mailing Address
200 Ridgefield Court, Suite 218, Asheville, NC 28806
Provider Appeals
Description / Hours
Providers may appeal an adverse action or sanction within 30 days. Network providers must appeal via the Appeals tab on Vaya’s Provider Portal. Out-of-network providers may appeal claim denials within 30 days of the publication of the RA/835 Electronic RA by submitting to ClaimsReconsideration@vayahealth.com the Request for Claims Denial Appeal (Level 1) Form located on Vaya’s Provider Central website. Out-of-network providers may appeal to ProviderReconsiderations@vayahealth.com for other adverse actions or sanctions by using the form attached to the original notice of action.
Phone Number
For claims-related appeals: 1-800-893-6246, ext. 2455; for all other appeals: 1-800-893-6246, ext. 5132
Physical Address
200 Ridgefield Court, Suite 218, Asheville, NC 28806
Pharmacy Services
Vendor Name
Navitus Health Solutions
Description
Pharmacy Benefits Manager
Web Link
Phone Number
For members, prescribers, and pharmacies: 1-800-540-6083
Fax Number
For prior authorizations: 1-855-673-6507
Vendor Name
Vaya Health
Description
Physician Administered Drug Program
Web Link
Phone Number
1-866-990-9712
Fax Number
PADP off-label/requests: 828-398-0571
Nurse Line
Description / Hours
Available 24 hours a day, seven days a week to Vaya Tailored Plan Medicaid members who have basic questions about symptoms or medications or would like advice on when to go to their primary care provider
Phone Number
1-800-290-1623
Behavioral Health Crisis Line
Description / Hours
Available 24 hours a day, seven days a week, to all members, recipients, and residents of Vaya’s region experiencing a mental health or substance use disorder crisis
Phone Number
1-800-849-6127 (TTY/TDD 711)
Interpreter Services
Vendor Name
Argo Translation
Description
Translation services
Web Link
Phone Number
1-844-459-5411
Fraud, Waste, and Abuse Hotline
Description / Hours
Report fraud, waste, and abuse
Phone Number
1-866-916-4255
ID Cards
Front
Back
Patient Care
Description
Vaya’s Member and Recipient Services team helps with a variety of care needs. Individuals may call us to ask about benefits and services, get information about care coordination and tailored care management, get help with referrals, replace a lost Medicaid card, or ask about any change that might affect their benefits.
Phone Number
1-800-962-9003 (TTY 711)
Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS)
Vendor Name
Vaya works with multiple DMEPOS vendors
Description
DMEPOS vendors can be found by using Vaya’s online Provider Search tool
Phone Number
1-800-962-9003 (Vaya Health Member and Recipient Service Line)
Transportation
Vendor Name
Modivcare Solutions, LLC
Description
Non-emergency medical transportation
Web Link
Phone Number
Reservations and ride assistance: 1-855-397-3614; NEMT Facility: 1-855-397-3606
Vision
Vendor Name
Avēsis Third Party Administrators, LLC
Description
Vision Services
Web Link
Phone Number
For members: 1-866-889-4457; For providers: 1-833-282-2427