Vaya Health is a Medicaid managed care organization contracted with the N.C. Department of Health and Human Services to operate the 1915 (b)/(c) Medicaid Waiver in our 23 counties. The Medicaid Waiver allows us to limit participation in our provider network. Our provider network is closed and we are not currently accepting direct applications for participation except from hospitals (please see the Credentialing page for a link to the hospital application). Exceptions are only made based on specific service needs and to ensure adequate access to care for our members. You can also visit our Procurement page to see if we are actively seeking applications for network participation.
Outside of the procurement process, enrolling in the network involves the process of submitting a request for nomination to Vaya Health so that the request may be evaluated to determine if the services are needed in the network. Our current service needs include prescribers and physician practices. We encourage prescribers and physician practices interested in delivering services to our members to submit a request for nomination form as indicated below.
Providers approved for network enrollment will be contacted by the Credentialing Team and provided with the appropriate credentialing application. Please note that network enrollment approval does not guarantee a provider will meet credentialing requirements and be offered a contract. If the provider is approved by the Credentialing Committee, a contract will be offered. For more information about credentialing, please visit our Credentialing page.
Once a provider is enrolled, credentialed and contracted for network participation, contract renewal and re-enrollment is based on provider performance and other factors outlined in the selection and retention criteria found in our Provider Operations Manual.
If you are not enrolled in our network but need to request an out-of-network agreement in order to provide care to one of our members who is unable to be served by an in-network provider, please follow the Out-of-Network process indicated below.
All requests for network enrollment must be sent to Vaya Health utilizing the appropriate form as indicated below. Instructions for submission are included on each of the forms.