As a Vaya Partners network provider, you have the right to report concerns and file grievances through a distinct provider process. Vaya Partners strictly prohibits discrimination or retaliation against any network provider based on submission of a grievance.
A provider grievance is a verbal or written concern expressing dissatisfaction related to NC Medicaid services administered by Vaya Partners or its subcontractors, except for disputes in which the provider has the right to appeal. Applicable subcontractors include VayaPartners’ provider of non-emergency medical transportation (NEMT) or our pharmacy benefits manager (PBM).
A provider complaint is the same as a provider grievance but is related to Vaya Partners’ administration of state-funded (non-Medicaid) services.
To learn more about appeals of provider adverse determinations, visit our Provider Appeals page.
How do I submit a grievance or complaint?
To submit a grievance or complaint, visit our online Provider EthicsPoint Portal. Vaya Partners’ “no wrong door” approach also allows you to submit a grievance or complaint in any of the following ways:
- ACCESS Provider Services: 1-866-990-9712, 7 a.m. to 6 p.m., Monday – Saturday, including holidays
- Grievance ResolutionTeam (GRT): 1-800-893-6246, ext. 1600
- Vaya Partners Compliance Hotline: 1-866-916-4255 (allows for anonymous reporting)
- Vaya Partners, Attn: Grievance ResolutionTeam, 901 S. New Hope Road Gastonia, NC 28054
- Email: ResolutionTeam@vayapartner.org
- Online: EthicsPoint
EthicsPoint allows for anonymous reporting. It is an online compliance and grievance/complaint intake platform for members, community stakeholders, providers, and Vaya Partners staff. EthicsPoint assigns an individualized report key to each case, as well as a password. You should keep this password in a safe place, as Vaya Partners staff cannot update or retrieve passwords.
Additionally, a written grievance or complaint may be hand-delivered, faxed, emailed, or mailed to Vaya Partners’ administrative office in Gastonia or to any staff member.
Pharmacy service providers and staff may also report concerns by directly contacting the PBM through its toll-free service line, by mail, via email, or via its online portal. Vaya Partners’ NEMT service provider and staff may also report concerns by directly contacting the NEMT provider through its toll-free service line, by mail, via email, or via its online portal.
How will my grievance or complaint be resolved?
Vaya Partners handles provider grievances promptly, consistently, fairly, and in compliance with state and federal law. NCDHHS requirements, and accrediting body guidelines. Within five calendar days of receipt of the provider grievance or complaint, we will send a written acknowledgment via email to the filer(s).
Our efforts to resolve a grievance or complaint may include:
- Phone interviews with the filer to obtain additional information or clarification
- Consultation with Vaya Partners or subcontractor staff, including licensed clinicians and subject matter experts
- Provider record request and record review
- Phone interviews with individuals who have a legitimate role in the issue to be resolved
Any Vaya Partners or subcontractor staff member attempting to resolve the grievance or complaint cannot have been involved in any previous level of decision-making regarding the issue at hand.
Within 30 days of receipt of a provider grievance or complaint, Vaya Partners or the applicable subcontractor will send a Notice of Grievance or Complaint Resolution to the filer. This notice identifies efforts made to resolve the issue, the findings, and any proposed resolution.
A grievance or complaint is considered resolved when one of the following occurs:
- The filer withdraws the grievance or complaint.
- The GRT determines the grievance or complaint is outside the purview of Vaya Partners and/or makes a referral to an appropriate state agency or licensure board.
- Vaya Partners or applicable subcontractor staff have taken all reasonable steps to address the grievance or complaint, and no further action can be taken to assist the filer.