Alliance has report managers who review the incident reporting system daily. Incident report managers may contact providers on behalf of these committees to request additional information.
Incident Report Managers review IRIS entries for the following:
- Timeliness of incident reporting and submission (i.e. immediate verbal/electronic notification of Level III incidents, IRIS submission within 72 hours for all incidents) and of provider responsiveness to LME/MCO requests for additional information in IRIS (i.e. by end of the next business day).
- Appropriate leveling and categorization of the incident.
- Notification of guardian, relevant agencies and others (DSS, HCPR, police, DHSR, etc.).
- Sufficient narrative regarding incident cause (including triggers) and effective prevention.
Late submissions: Incident reports that are not submitted in IRIS within three days of the incident (or of learning of the incident) are considered late. Providers may receive sanctions, up to a Plan of Correction for chronic late submission of incident reports.
Quarterly reporting: Alliance has received a waiver from the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services for Level I incident reporting. Providers are not required to submit QM11 forms until further notice. Providers still are required to track Level I incidents as noted below.
Incident reporting reminders:
- For Level III incidents, providers are responsible for contacting the LME/MCO as soon as possible (or no later than 24 hours of the incident occurrence). Verbal notification is strongly encouraged by contacting the appropriate incident report manager or calling Alliance Member and Recipient Services at 800-510-9132. Notifications can also be mailed to Incidents@AllianceHealthPlan.org.
- Incident reports can be emailed to Incidents@AllianceHealthPlan.org. This includes Level II and Level III incident (IRIS) reports by out-of-state providers submitted in accordance with incident reporting timelines. They can also be faxed to 919-651-8667.
- All Level II and Level III incidents must be entered into IRIS within 72 hours of learning of the incident. (If IRIS cannot be accessed within that timeframe, providers may email or fax QM02 DHHS Incident and Death Report form. The provider is still responsible for entering the incident in IRIS as soon as the system is available.) Failure to submit the incident via IRIS may result in a plan of correction.
- All Level I incidents should be maintained by providers, separate from clinical records, at the provider’s site. They may be reviewed during provider monitoring or by request.
Helpful resources for incident reporting:
IRIS Technical Manual
IRIS Reporting Manual (refer to pp. 20- 25, Appendix B for detail on incident categories)
IRIS Website
NC Medical Examiner/Document Request
Death certificates: obtained by contacting the Dept. of Vital Statistics of the county where the person died. (A copy of the death certificate should be attached to the incident report in IRIS. A certified copy of the death certificate is not necessary, a copy is fine.)
Division of Health Services Regulation (DHSR) Complaint Line: (800) 624-3004
DHSR/Health Care Personnel Registry (HCPR) Reporting Allegations: (919) 855-3968/fax (919) 733-3207
Reporting Grievances/Complaints
Grievances/complaints can be emailed to Complaints@AllianceHealthPlan.org. They can also be submitted by calling Alliance Member and Recipient Services at 800-510-9132.
