How to Access NC Medicaid Direct Services
Vaya can help you get the care and services you need for most behavioral health, I/DD, and TBI needs. You can:
- Call Vaya’s toll-free Member and Recipient Services line at 1-800-962-9003 (Monday through Saturday, 7 a.m. to 6 p.m.). This line is available 24 hours a day, every day of the year.
- Visit a walk-in center in your county during normal business hours and ask for services. To get the name, number, and address of the walk-in center closest to you, call Member and Recipient Services or go to our Walk-in Centers website page.
- Go directly to a provider in our network. The provider can help you get enrolled in services. You may schedule your appointment directly with the provider or walk into their office.
If you have questions about Medicaid eligibility or need to update your Medicaid information, you can contact your local Department of Social Services (DSS) office.
How to Choose or Change Your PCP
Your PCP is a doctor, nurse practitioner, or physician assistant who will:
- Care for your physical health when you are well and sick.
- Help you get referrals for specialized services if you need them (like a cardiologist).
As a Medicaid beneficiary, you have an opportunity to choose your own PCP. You can find your PCP’s name and contact information on your Medicaid ID card. If you do not choose a PCP, NC Medicaid may choose one for you based on your past health care.
- You can change your PCP at any time and for any reason. If you have any questions about choosing or changing your PCP, call your local DSS office. A list of DSS locations can be found here: ncdhhs.gov/localdss.
Behavioral Health Emergencies
If you need help with a mental health or drug use situation, feel stressed or worried or need someone to talk to, you can call the Behavioral Health Crisis Line at 1-800-849-6127, at any time, 24 hours a day, 7 days a week.
Out-of-Network Referrals and Out-of-Network Providers
- If Vaya does not have a specialist in our provider network who can give you the care you need, we will refer you to a specialist outside our LME/MCO or an out-of-network provider. This is called an “out-of-network referral.” A network provider must ask Vaya for prior authorization (approval) before you can get an out-of-network referral.
- To request care from an out-of-network provider, talk to your PCP or call Member and Recipient Services at 1-800-962-9003. Once Vaya has received all the information we need to review the out-of-network referral, we will let you know our decision as soon as possible. To check on the status of the referral, call Member and Recipient Services at 1-800-962-9003.
- Sometimes we may not approve an out-of-network referral because Vaya has a provider who can treat you. If you do not agree with our decision, you can appeal our decision.
- Sometimes, we may not approve an out-of-network referral for a specific treatment because you asked for care that is similar to what you can get from a Vaya provider. If you do not agree with our decision, you can appeal our decision.
- For more information about getting services from an out-of-network provider, call Member Services at 1-800-962-9003.
Care Outside North Carolina and the United States
In some cases, Vaya may pay for services you get from a provider located along the North Carolina border or in another state. Vaya can give you more information about which providers and services are covered outside of North Carolina and how you can get them if needed.
- If you need medically necessary emergency care while traveling anywhere within the United States and its territories, Vaya will pay for your care.
- Vaya will not pay for care received outside of the United States and its territories.
If you have any questions about getting care outside of North Carolina or the United States, call Member Services at 1-800-962-9003.