All network providers are reimbursed at the lesser of the Vaya Partners published rates for the service being provided or your usual and customary charge for the services, unless otherwise stated in your contract or identified in the ProviderCONNECT portal. In general, Vaya Partners follows the NC Medicaid fee schedule for Medicaid services.
Rate changes are announced at least 30 days in advance unless they result from a change imposed by the General Assembly, NC Medicaid, or the NC Division of Mental Health, Developmental Disabilities, and Substance Use Services. You can submit claims for more than the published rates, but only the published or contracted rate will be paid.
If you submit a claim for less than the published or contracted rate, the lower rate will be paid. It is the provider’s responsibility to monitor the publishing of rates and to make the necessary changes to their billing systems.
Vaya Partners Rate Schedules effective Oct. 1, 2026
- Standard Rate Schedule: Tailored Plan/Medicaid Direct Clinician-Based (10/01/2026)
- Standard Rate Schedule: Tailored Plan/Medicaid Direct Non-Clinician-Based (10/01/2026)
- Standard Rate Schedule: Medicaid 1915(c) (10/01/2026)
- Standard Rate Schedule: Medicaid 1915(i) (10/01/2026)
- Standard Rate Schedule: Non-Medicaid Clinician-Based (10/01/2026)
- Standard Rate Schedule: Non-Medicaid Non-Clinician-Based (10/01/2026)
- Vaya Partners Procedure Code Crosswalk (10/01/2026)
Tailored Plan physical health and behavioral health, I/DD, and TBI rates (facility)
Vaya Partners’ Behavioral Health I/DD Tailored Plan rates for physical health services and behavioral health services delivered in a facility follow the NC Medicaid Fee Schedules. Vaya Partners pays the published facility rate for claims submitted with the following place of service (POS) codes:
- Outpatient Hospital-Off campus (POS Code 19)
- Inpatient Hospital (POS Code 21)
- Outpatient Hospital-On campus (POS Code 22)
- Emergency Room-Hospital (POS Code 23)
- Ambulatory Surgical Center (POS Code 24)
- Military Treatment Facility (POS Code 26)
For guidance, review Tailored Plan Programs and Fee Schedules and Vaya Partners’ Guide to Accessing NC Medicaid Fee Schedules.
Vaya Partners does NOT cover physical health services for NC Medicaid Direct members. Please bill these services to NC Medicaid. For more information, review the Covered Procedure Codes page of the NC Medicaid website.
Checkwrite schedule
Vaya Partners adheres to the standardized LME/MCO checkwrite schedule, which is based on a 5 p.m. Tuesday cutoff. Claims received before this cutoff date will be paid the following week according to the checkwrite schedule. The schedule accommodates state and federal holidays occurring during the work week.