Provider tools

Critical incidents

Critical incidents shall include but not be limited to the following incidents when they occur in settings such as nursing facilities, inpatient behavioral health, or home and community-based services settings (adult day care center, a member’s home, or any other community-based setting) in the provision of care by MCC of VA staff and contract providers.

  • Unexpected death of a MCC of VA member;
  • Suspected physical or mental abuse of a MCC of VA member;
  • Theft against a MCC of VA member;
  • Financial exploitation of a MCC of VA member;
  • Severe injury sustained by a MCC of VA member;
  • Fall of a MCC of VA member;
  • Medication error involving a MCC of VA member;
  • Sexual abuse and/or suspected sexual abuse of a MCC of VA member; and
  • Abuse and neglect and/or suspected abuse and neglect of a MCC of VA member.

Providers must report Critical Incidents and actions to MCC of VA:

  • Within 24 hours* of the Provider’s discovery/awareness of the critical incident.
  • If the initial report is submitted verbally, a written MCC of VA Critical Incident Report form must be submitted to MCC of VA within 48 hours*.
  • Reports may be submitted verbally by calling 1-800-424-4524, by secure e-mail to, or by fax at either 423-591-9525 or 866-325-9157, 24 hours/day, 365 days/year.

Additional requirements:

  • Immediately, and not to exceed 24 hours*, the Provider must take steps to prevent further harm to any and all members and respond to any emergency needs of members.
  • Providers must conduct an internal critical incident investigation and submit a report on the investigation as soon as possible, and no later than thirty (30) days after the date of the incident. MCC of VA will review the provider’s report and follows up with the provider as necessary to ensure that an appropriate investigation was conducted and corrective actions were implemented within applicable timeframes.
  • Providers are required to cooperate with any investigation conducted by MCC of VA or outside agencies (e.g., DMAS, Adult Protective Services, and law enforcement).

Issues related to non-compliance may be escalated to the MCC of VA Provider Credentialing Committee for evaluation of the provider’s continued credentialing eligibility.

You may access the current version of the MCC of VA Critical Incident Report form below. You may also obtain a copy of the form by calling 1-800-424-4524.

* Note: 24- and 48-hour timeframes equal actual clock hours - NOT business day(s).

Critical Incident Report Form (PDF)



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