We hope Vaya Partners serves you well. If you are unhappy or have a complaint, you may talk with your provider or contact us.
Under Medicaid, a complaint is called a grievance. Contacting us with a grievance means that you are unhappy with Vaya Partners, your provider, or your health services.
Most problems like this can be solved right away. Whether we solve your problem right away or need to do some work, we will record your call, your problem, and our solution. We will inform you that we have received your grievance in writing. We will also send you a written notice when we have finished working on your grievance.
You can ask a family member, a friend, your provider, or a legal representative to help you with your grievance or the grievance process. They must have your written consent to file a grievance for you. If you need our help because of a hearing or vision impairment, or if you need translation services or help filling out any forms, we can help you.
What are examples of grievances?
Grievances could involve matters such as:
- Staff not keeping an appointment or being late to an appointment
- Staff not being respectful to you
- Concerns about provider quality of care
- Lack of access to services where you live or services that are not allowed on your benefit plan
- Attitude of Vaya Partners staff and providers
- Billing and financial issues
- Quality of your practitioner’s office or facility
- Dissatisfaction with your care manager
Medicaid Grievances Q&A
Vaya Partners follows a “no wrong door” approach for submitting grievances. You can file a grievance in any of the following ways:
- BY PHONE: Call ACCESS Member Services at 1-888-235-4673 or our Grievance Resolution and Incident Team at 1-800-893-6246, ext. 1600. You can also report concerns anonymously through Vaya Partners’ toll-free, 24/7 Compliance Hotline at 1-866-916-4255.
- ONLINE: Visit the Vaya Partners EthicsPoint compliance portal at ethicspoint.com (also allows you to report anonymously) or submit a grievance through our online MemberCONNECT portal
- BY EMAIL: resolutionteam@vayapartners.org
- BY MAIL: Write to us at Vaya Partners, Grievance Resolution and Incident Team, 901 S. New Hope Rd. Gastonia, NC 28054
Vaya Partners will let you know in writing that we got your grievance within five days of receiving it. We will review your grievance and tell you how we resolved it in writing within 30 days. This is called a resolution letter.
This timeframe can be extended by 14 calendar days if you request the extension or there is a need for additional information and the delay or extension is in your best interest.
If your grievance is about your request for an expedited (faster) appeal, we will tell you how we resolved it in writing within five days of receiving it.
If you are not satisfied with how Vaya Partners resolved your grievance, you may appeal our decision in writing within seven calendar days from the date of the resolution notice or escalate your grievance to the North Carolina Department of Health and Human Services, NC Medicaid (Division of Health Benefits).
The resolution letter will include information on how to file an appeal with Vaya Partners. You can request an appeal in several ways:
- BY PHONE: Call ACCESS Member Services at 1-888-235-4673 or Vaya Partners’ Grievance Resolution and Incident Team at 1-800-893-6246, ext. 1600
- BY EMAIL: resolutionteam@vayapartners.org
- BY FAX: 1-704-884-2713
- BY MAIL: Write to Vaya Partners, Attn: Grievance Resolution and Incident Team, 901 S. New Hope Rd. Gastonia, NC 28054
- IN PERSON: You may hand-deliver an appeal to Vaya Partners’ administrative office at 901 S. New Hope Rd. Gastonia, NC 28054
Your appeal will be reviewed within 21 calendar days from the date Vaya Partners receives your request. Once a decision is made, Vaya Partners will send you a written Appeal Resolution Notice, which informs you of our final decision. There is no further appeal at Vaya Partners beyond this review.
For more information about escalating your appeal to NC Medicaid, you can contact the NC Medicaid Ombudsman at us at 1-877-201-3750 from 8 a.m. to 5 p.m., every Monday through Friday except for State holidays.
