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NC Medicaid has changed the start date for Tailored Plans to October 1, 2023. Until then people will keep getting services the way they do now.

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Quality Management and Incident Reporting

The Alliance Quality Management Department develops and implements a quality management system including data management and reporting that is integrated philosophically throughout the organization to ensures a quality experience for each member.

DHHS Reports

Incident Reporting

Alliance has two incident 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 3s, 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. To promptly address the late submission of Level II and Level III incident reports, the following steps will be taken:

  1. An email notification or certified letter will be issued to executive leadership/management of any provider who submits a Level II or Level III Incident Report late.
  2. A plan of correction will be issued to any provider who:
    a. Receives two written notifications in the same quarter
    b. Receives two written notifications in two consecutive quarters in the current fiscal year
    c. Receives three written notifications within the current fiscal year

Quarterly reporting: Alliance has received a waiver from the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services for Level 1 incident reporting.  Providers are not required to submit QM11 forms until further notice. Providers still are required to track Level 1 incidents as noted below.

Incident reporting reminders:

  • For Level 3 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 Access and Information Line 1-800-510-9132. Email notification is also acceptable.
  • All Level 2 and 3 incidents must be entered into IRIS within three days 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 1 incidents should be maintained by providers, separate from clinical records, at the provider’s site. They may be reviewed by during provider monitoring.

Helpful resources for incident reporting:

Medicaid Transformation Changes in IRIS 
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

Incident Reporting Contact Information

Incident Reporting Contact Information
IncidentsDiana Sofia
Jessica Killette
Malaika Brathwaite
[email protected]
(919) 651-8481
(919) 651-8481
(919) 651-8534
(919) 651-8687
(919) 651-8687
(919) 651-8687
[email protected]
NC SNAPSDiane Sofia(919) 651-8481(919) 651-8687
Grievances/Complaints(800) 510-9132[email protected]

Alliance Health has created an email box to be used for the submission of Level II and Level III incident (IRIS) reports by out-of-state providers. All out-of-state providers should submit Level II and Level III IRIS reports to [email protected] in accordance with incident reporting timelines.

This page was last reviewed for accuracy on 11/08/2020