We are committed to ensuring the health and safety of all our members. As such, we are required to monitor certain incidents that occur involving contract providers and providers who operate within our catchment area.
An incident is an event (at a facility or in a service) that is likely to lead to adverse effects upon a member. Incidents are classified into several categories according to the severity of the incident. Contract 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. In addition, you must submit a summary of all Level I incidents to Vaya Health on a quarterly basis. Out-of-state providers must submit paper copies of the incident report to DHHS and to us.
Incident reports are submitted via the Incident Response Improvement System (IRIS).
Please be prepared to respond promptly to follow-up inquiries requesting clarification or additional information by the Incident Report Team (IRT).
To reduce the number of these requests, please check to 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
Indicate requested documentation in the Comments Section (e.g. Medical Examiner’s report, death certificate, DSS response letter, etc.)
In addition, please complete this form in the event of Failing to Provide BackUp Staff for an Innovations Incident. Providers are not required to submit this information to us directly but are required to have it upon request from Care Coordinators or Provider Monitoring.
Below is a video of the Incident Response Improvement System (IRIS) webinar training that we hosted for providers. The Incident Report Team will be still available for questions by email or phone and to do one on one trainings of IRIS.
Providers must report ALL consumer deaths whenever they become aware of it—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 by ‘unknown cause’ until official documentation from a Medical Examiner determines otherwise.
According to the Joint Communication Bulletin the following process should be followed for backup staffing. It is the expectation that 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 the LME-MCO. You may read more about this in the Joint Communication Bulletin.
- To report this lack of staffing you may use the new Back-Up Staffing Form here.
|Calendar Days||Due Date||Example|
|1st-15th||Last day of the current month||BUS incidents occurring August 1st, and August 4th – those two dates would be reported in the August 30th spreadsheet|
|16th-30th(31st)||15th of next month||BUS incidents occurring August 20th, and August 25th – those two dates would be reported in the September 15th spreadsheet|
All Back Up Staffing reports need be sent by the above noted due dates to firstname.lastname@example.org