North Carolina's behavioral healthcare landscape entered a new phase on October 1, 2026, when Vaya Health and Partners Health Management merged to create Vaya Partners.
The official North Carolina Medicaid merger announcement states that Medicaid benefits remain unchanged following the merger. Healthcare providers should also examine the operational guidance covering claims, contracts, reimbursement, and authorization.
For behavioral health agencies and ABA practices, understanding these operational requirements is especially important. Accurate billing and up-to-date records can help avoid delays, while consistent tracking is also essential. This guide details the Vaya Partners merger, the areas providers should review, and ways practices can safeguard their revenue cycle during the transition.
What Does the Vaya Partners Merger Mean?
Vaya Health and Partners Health Management supported eligible individuals requiring behavioral health services, substance use disorder treatment, intellectual and developmental disability (I/DD) services, and traumatic brain injury services.
On October 1, 2026, the organizations combined to become Vaya Partners. Vaya Partners serves a 47-county region and supports the state's Medicaid Behavioral Health and I/DD Tailored Plan, along with services provided through NC Medicaid Direct.
Providers can visit the official Vaya Partners website for organizational details and the latest announcements.
Not all North Carolina Medicaid health plans have merged. This change concerns Vaya Health and Partners Health Management, along with the services they administer.
Did the Vaya Partners Merger Alter Medicaid Benefits?
North Carolina Medicaid states that member benefits remain unchanged as a result of the merger. Members who were eligible were automatically enrolled with Vaya Partners and do not need to take any additional steps to continue receiving their current services.
However, practices should continue verifying eligibility, plan participation, and payer requirements before submitting claims. An established patient relationship does not guarantee that the same billing arrangement, authorization process, or network agreement applies to every service after the payer changes.
Providers should consult the official Medicaid merger guidance when addressing questions related to members.
1. Review Requirements for Medicaid Claims Submission
Following the Vaya Partners merger, claims submission is among the most important operational areas to examine.
The pre-merger Provider Communication Bulletin #180 provides transition-related instructions on claims routing, payer identification, and reimbursement information.
The bulletin states that the applicable payer ID is determined by the originating organization and date of service:
• Services dated October 1, 2026, or later: Payor ID 13010 is identified for Vaya Partners claims.
• Vaya Health services dated before October 1, 2026: Payor ID 13010 is also identified for these legacy claims.
• Partners Health Management behavioral health services dated before October 1, 2026: Payor ID 13141 is identified for these legacy claims.
These instructions should be compared with the current official billing guidance, especially for paper claims, other claim types, and services administered through different arrangements.
Why is accurate claims routing important?
Incorrect payer information, outdated billing setups, and incomplete claim details can cause rejections and delays while also creating additional follow-up work.
Healthcare organizations should begin by checking eligibility, followed by validating provider information and using the correct submission instructions. After adjudication, they also review the remittance advice to confirm that everything is in order.
Practices seeking to improve these workflows can consider medical billing services from All State RCM, which cover claims submission, rejection resolution, payment posting, and accounts receivable follow-up within the agreed service scope.
2. Verify Provider Contracts and Credentialing Records
The merger also provides a reason to review provider contracts and enrollment records.
Practices should verify their network participation, relevant contract amendments, covered services, and approved locations. Providers should not assume that every prior contractual arrangement automatically applies to all services under the combined organization.
Important areas for review include:
•National Provider Identifiers (NPIs) for groups and individuals.
•Provider taxonomy and enrollment details.
•Approved service sites and covered services.
•Current payer agreements and applicable fee schedules.
•Lists of rendering clinicians and credentialing documentation.
•Electronic data interchange (EDI), electronic remittance advice (ERA), and electronic funds transfer (EFT) arrangements, when applicable.
Providers must also keep their required enrollment information current in NC Tracks and other applicable payer systems.
Newly established behavioral health agencies should carefully consider the order of credentialing, contracting, and enrollment requirements before submitting service bills.
For administrative help with payer applications, enrollment records, CAQH profile updates, and recredentialing, consider All State RCM's provider credentialing services.
Credentialing support helps organize and monitor the administrative process, while payers retain authority over participation decisions, contracting, and effective dates.
3. Review Reimbursement Rates and Procedure Codes
Vaya Partners released updated standard rate schedules and a procedure-code crosswalk for the transition on October 1, 2026.
The official Provider Communication Bulletin #180 directs providers to the relevant rate details and transition updates. Some service schedules and arrangements were modified, but this does not indicate that every procedure code or provider received a rate adjustment.
Practices should examine the schedule that applies to their particular service, funding stream, and payer arrangement.
Recommended reviews include:
• Verifying procedure codes and relevant code crosswalks.
• Examining contracted reimbursement rates.
• Updating fee schedules in billing software when necessary.
• Verifying units, modifiers, and requirements at the claim level.
• Comparing anticipated reimbursement with the payer’s remittance advice.
• Investigating underpayments and adjustments that lack an explanation.
For behavioral health and ABA practices, particular attention should be given to code accuracy and contract alignment because billing rules may differ depending on the service and payer arrangement.
Do not apply a blanket rate adjustment to all services without first confirming the specific requirements.
4. Review Prior Authorization Requirements
Managing authorizations is an important component of the revenue cycle.
Practices should examine current authorizations, approved units, service dates, and applicable service definitions to ensure claims satisfy the requirements.
Vaya Partners announced temporary flexibilities for prior authorization for certain physical health services starting October 1, 2026. These flexibilities should not be understood to mean that behavioral health or ABA authorization requirements have been waived.
Providers should confirm the current requirements for each member, service, and plan through the official Vaya Partners provider resources.
Before billing services, practices should verify authorization validity, approved units, expiration dates, required documentation, and reauthorization timelines.
Effective communication among clinical, authorization, and billing teams can help minimize preventable discrepancies and delays.
5. Monitor Denials and Outstanding Accounts Receivable
Payer transitions can expose billing issues that might otherwise remain undetected, particularly for claims covering multiple service dates.
Billing teams should also track claim acknowledgements, rejections, denials, payment postings, and unresolved accounts receivable. Claims should be reviewed based on their status, root cause, and applicable filing or appeal deadlines.
Recurring denials may indicate issues involving eligibility, authorization, provider enrollment, coding, documentation, or payer configuration.
Practices may benefit from evaluating All State RCM's denial management services
The objective is not merely to resubmit claims that were denied. Instead, it is to determine the cause of the issue, fix whatever can be corrected, and keep the same problem from impacting future submissions.
6. Use Current Provider Resources
Providers should rely on the official Vaya Partners website and the relevant provider portal as their primary sources for up-to-date requirements.
Helpful resources include:
•Official Vaya Partners website
•Vaya Partners provider portal
•Provider Communication Bulletin #180
•Provider Communication Bulletins and Updates
These resources assist providers in reviewing claim instructions, reimbursement details, enrollment guidance, authorizations, and operational announcements.
Since transition-related guidance may change, practices should confirm the latest instructions rather than relying only on previously saved procedures or older provider documents.
Practical Checklist for Behavioral Health and ABA Practices
To minimize preventable administrative disruptions, practices should conduct a structured review of their revenue cycle.
Eligibility and enrollment
•Verify the member's eligibility and applicable plan.
•Confirm that provider enrollment is active and network participation is in place.
•Review records for clinicians, groups, and service locations.
Credentialing and contracts
•Check contracts and any applicable amendments.
•Verify the services and locations that have been approved.
•Examine credentialing and enrollment status for every relevant provider.
Billing and reimbursement
•Use the appropriate payer guidelines according to the date of service.
•Confirm the relevant payer IDs and submission procedures.
•Examine rate schedules and procedure-code crosswalks.
•Match claims against remittance advice and examine any discrepancies.
Authorizations and documentation
•Confirm the authorization requirements that apply.
•Monitor approved units and authorization expiration dates.
•Ensure that the documentation supports the services billed.
•Examine denials and track relevant correction or appeal deadlines.
For more preparation guidance, practices may refer to All State RCM's provider credentialing readiness checklist.
How Revenue Cycle Management Can Help During a Payer Transition
Payer transitions can create additional administrative demands for practices already responsible for patient care and other duties.
Revenue cycle management connects financial and administrative processes to help convert completed services into appropriate reimbursement.
Behavioral health practices may also have to verify eligibility, monitor authorizations, submit claims, post payments, handle denials, follow up on accounts receivable, and obtain credentialing support.
With a coordinated process, practice owners gain a clearer understanding of outstanding claims, recurring billing problems, and reimbursement performance.
All State RCM assists healthcare practices with medical billing services, mental and behavioral health billing, and provider credentialing, based on the level of support needed.
These services are intended to help practices oversee administrative workflows while allowing their teams to remain focused on patient care.
Do you need assistance with medical billing or credentialing? Visit All State RCM to explore the available services and request a consultation.
Frequently Asked Questions About the Vaya Partners Merger
When did the merger between Vaya Health and Partners Health Management occur?
The merger took effect on October 1, 2026, and Vaya Partners is the name of the new organization.
Did the merger affect North Carolina Medicaid benefits?
NCDHHS states that the merger did not change Medicaid benefits. Additionally, members are now part of Vaya Partners and do not need to take any action to maintain their benefits.
Which payer ID should providers use when assigning Vaya Partners claims?
For claims with a service date of October 1, 2026, or later, the correct payer ID is 13010. For legacy claims, the instructions may differ depending on the original organization, claim type, and service date, so the applicable instructions for each claim must be reviewed before submission.
Do behavioral health providers need to review their contracts?
Yes. Providers must confirm that their contracts, contract amendments, network participation agreements, services, locations, and enrollment are consistent with their agreements with Vaya Partners.
Have reimbursement rates changed for providers?
Vaya Partners issued updated rate schedules and a procedure-code crosswalk for reference. Providers should also consult the appropriate rate schedule for the services they deliver rather than assume that every procedure code has been affected.
Do providers still need to obtain prior authorizations?
Providers should continue verifying authorization requirements for each member and service. Moreover, temporary flexibilities for specific physical health services do not constitute a broad waiver for behavioral health and ABA services.
Final Thoughts
The Vaya Partners merger marks a major change in North Carolina’s public behavioral healthcare system. Although the merger does not affect Medicaid benefits, providers should examine several issues involving claims, contracts, reimbursements, enrollment, and authorization. A thorough review can help behavioral health and ABA practices identify various administrative discrepancies impacting a substantial number of claims.
The primary focus should be on confirming current payer requirements and revising procedures and documentation as needed. Claims should also be monitored to confirm they are processed accurately and without delays.
This article is intended for general educational purposes. Payer instructions and requirements may change. Providers should consult current official Vaya Partners and NCDHHS guidance for requirements applicable to their services and claims.
