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Authorization Requests for Dates of Service Beginning Oct. 1

In preparation for the upcoming Oct. 1, 2026, merger of Vaya Health and Partners Health Management (Partners), Tailored Plan and NC Medicaid Direct member eligibility has changed in NCTracks to Vaya Partners. This change is resulting in providers receiving invalid eligibility messages when trying to enter authorization requests in ProAuth for dates of service beginning Oct. 1.

This change does not affect member Medicaid eligibility.

What is happening?

  • NCTracks has updated member eligibility to Vaya Partners for authorization requests with dates of service beginning Oct. 1, 2026.
  • This is resulting in providers getting invalid eligibility messages when they attempt to enter authorizations in ProAuth for services beginning on that date.
    • This message appears because member benefit plan eligibility for Oct. 1, 2026, has already transitioned to Vaya Partners.

What do providers need to know?

  • Providers cannot submit authorization requests in ProAuth with service dates beginning on Oct. 1, 2026.
  • Members should see no change in services at this time. The change does not affect their Medicaid eligibility.
  • Partners will not accept manual Service Authorization Requests (SARs) for initial or concurrent requests with a start date of Oct. 1, 2026, or later.
  • There are exceptions for members receiving Innovations and 1915(i) Tailored Care Management (TCM) Services.
    • Innovations and TCM authorization requests may be submitted in ProAuth through the usual process for Annual Service Plans effective on Oct. 1, 2026.

What do providers need to do?

  • On Oct. 1, 2026, providers should submit authorization requests through the Vaya Partners Provider Portal ProviderCONNECT, after eligibility has been loaded.
  • Providers are encouraged to review the Vaya Partners prior authorization flexibilities.
  • Providers should also review the following resources for information about Vaya Partners prior authorization flexibilities:
    • Vaya Partners Utilization Management Information Session:

Vaya Partners | Improving Lives. Strengthening Communities.

    • Partners Provider Alert issued Sept. 2, 2026:

Vaya Partners will implement prior authorization flexibilities beginning on Oct. 1, 2026. – Partners Health Management – Provider Knowledge Base.

Who can providers contact for more information?

Providers can call the Provider Services Line at 1-877-398-4145.

Updated: