Vaya Health is required to monitor certain types of incidents that occur involving network providers and other providers who operate within our catchment area.
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 N.C. Administrative Code. Out-of-state providers must submit paper copies of incident reports to the N.C. Department of Health and Human Services (DHHS) and to Vaya via fax at 828-398-4407.
Level II and Level III incident reports are submitted via IRIS. Level I incidents are to be documented on the provider agency’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 Grievance Resolution and Incident Team (GRIT) or DHHS. Please ensure all of the following items are included:
- 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
- Note that Vaya staff are unable to see incident numbers, so 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, etc.). For more information, please refer to the DHHS website or contact the Vaya GRIT at IncidentReport@vayahealth.com.
If IRIS is unavailable due to maintenance or technical issue, please print a hard copy of the incident report form from the DHHS website and submit it to Vaya via fax at 828-398-4407 and DMH/DD/SAS Customer Service and Community Rights Team via fax 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 N.C. Division of Health Service Regulation (DHSR) Complaint Intake Unit via fax at 919-715-7724. Reports to be filed with DHSR Healthcare Personnel Registry should be submitted to the Health Care Personnel Registry (HCPR) via fax at 919-733-3207 within specified timeframes.
When a provider becomes aware of a member death, he or she 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 within 24 hours of discovery. This can be done via phone, voicemail or email. The associated incident report should be submitted within 72 hours. All deaths are considered to be due to “unknown cause” until official documentation from a medical examiner determines otherwise.
All member deaths and Level III incidents will be reviewed by Vaya’s Critical Incident Review Committee (CIRC), chaired by our chief medical officer. 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 Joint Communication Bulletin (#J256), if a provider or Employer of Record (EOR) staff member is unable to provide a service and the provider agency or EOR is unable to provide back-up staff, the provider or EOR is required to report this lack of staffing to Vaya. To report, you may use 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 email@example.com.