Vaya Health is required to monitor certain types of incidents involving behavioral health, intellectual/developmental disability, and traumatic brain injury network providers and other providers who operate within our region.
An incident is an event that is not consistent with the routine operation of a facility or service or the routine care of a member and that is likely to lead to adverse effects for a member. For reporting purposes, incidents are divided into three levels:
- Level I: Events that, in isolated numbers, do not significantly threaten the health or safety of an individual but could indicate systematic problems if they were to occur frequently
- Level II: Incidents involving a threat to the health or safety of the member or another person due to the member’s behavior or member deaths caused by terminal illness or natural cause (when official documentation is provided)
- Level III: Incidents resulting in death (or posing a substantial risk of death) or sexual assault or that cause permanent physical or psychological impairment or incidents that are perceived to be a significant danger to, or concern of, the community
Network providers are required to report all Level II and Level III incidents in the state’s Incident Response Improvement System (IRIS). Failure to do so is a violation of your contract and the North Carolina Administrative Code. Out-of-state providers must submit paper copies of incident reports to the North Carolina Department of Health and Human Services (NCDHHS) via fax at 984-777-9864 and to Vaya via fax at 828-398-4407.
Quarterly Incident Reports
Vaya has obtained a waiver of Rule 10A NCAC 27G .0604(e) from NCDHHS. The approved request waives the requirement for providers to submit quarterly incident reports (Form QM 11) to Vaya through June 30, 2028. Providers must maintain Level I incident reports onsite and make them available to Vaya upon request. If you have questions, email IncidentReport@vayahealth.com.
How to contact us
- Fax the Grievance Resolution and Incident Team (GRIT) at 828-398-4407
- Incidents: IncidentReport@vayahealth.com
- Back-up staffing: backupstaffing@vayahealth.com
Documents
Incident Reporting Q&A
Level II and Level III incident reports are submitted via IRIS. Level I incidents are to be documented on the provider organization’s internal form and should not be submitted in IRIS. Learn more by viewing a Vaya provider IRIS training.
Be prepared to respond promptly to follow-up inquiries requesting clarification or additional information by Vaya’s GRIT or NCDHHS. Please include all the following items:
- A clear and detailed description of what caused the incident
- Actions taken in response to the incident
- A plan that explains how such an incident can be prevented from happening in the future
- Any supporting documentation that may help in assessment of the incident
Vaya staff are unable to see incident numbers. Remember to keep detailed records on all incidents for future reference.
Indicate requested documentation in the comments section (e.g., medical examiner’s report, death certificate, Department of Social Services response letter). For more information, refer to the NCDHHS website or contact the Vaya GRIT at IncidentReport@vayahealth.com.
If IRIS is unavailable due to maintenance or technical issues, print a hard copy of the incident report form from the NCDHHS website and fax it to Vaya at 828-398-4407 and the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Use Services’ Customer Service and Community Rights Team at 919-733-4962 within specified timeframes. Providers must enter the report into IRIS once the system is available.
Also, if IRIS is unavailable, reports regarding deaths (suicide, homicide/violence, accident, or restraint) in a licensed facility should be reported to the North Carolina Division of Health Service Regulation (DHSR) Complaint Intake Unit via fax at 919-715-7724. Reports to be filed with DHSR Health Care Personnel Registry (HCPR) should be faxed to 919-733-3207 within specified timeframes.
When a provider becomes aware of a member death, they must report it immediately in IRIS — even if the death occurred while the individual was not under the provider’s care.
Providers must give verbal notification by phone, voicemail, or email within 24 hours of discovery and submit the associated incident report within 72 hours. All deaths are considered to be due to “unknown cause” until official documentation from a medical examiner determines otherwise.
Vaya’s Critical Incident Review Committee (CIRC), chaired by our Chief Medical Officer, reviews all member deaths and Level III incidents. The CIRC may request additional documentation about the member. You must cooperate with this process and submit records as requested. If concerns are raised related to the member’s care or services, or your response to an incident, the CIRC will refer the matter for potential investigation.
According to NC Medicaid Clinical Coverage Policy 8P, if a provider or Employer of Record (EOR) staff member is unable to provide a service and the provider organization or EOR is unable to provide back-up staff, the provider or EOR must report the lack of staffing to Vaya using the Back-up Staffing Form.
Calendar days: 1st – 15th
Due date: Last day of the current month
Example: Back-up staffing incidents occurring between Aug. 1 and Aug. 15 would be reported in the Aug. 30 spreadsheet.
Calendar days: 16th – 30th (31st)
Due date: 15th of the next month
Example: Back-up staffing incidents occurring between Aug. 16 and Aug. 30 would be reported in the Sept. 15 spreadsheet.
All back-up staffing reports must be sent by the above due dates to backup.staffing@vayahealth.com.
Resources, Support Information, and Quick Links
Provider Support Service Line
Available 7 a.m. to 6 p.m., Monday – Saturday
Vaya Health Address
200 Ridgefield Court
Suite 218
Asheville, NC 28806