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Provider Alert

Provider Alert: Providers May Submit Request for Hardship Payment for Claims Denied Due to Cyberattack

Issued: March 14, 2024 In late February, Change Healthcare, a division of UnitedHealth Group, was impacted by a cybersecurity incident. (See Partners Feb. 22, 2024, Provider Alert below.) This cyberattack has affected Change Healthcare’s claims and payment infrastructure and disrupted claims processing across the United States. As a result, providers were asked to temporarily stop

Provider Alert: Utilization Management Update: Attention Davidson County Providers – Authorization Issues

Issued: March 4, 2024 Partners Utilization Management (UM) is working to input authorizations for Davidson County members that did not transfer properly from Sandhills Center. This means authorizations may be missing from both ProAuth and Alpha+ for some Davidson County members. What is happening? During the ingestion process, some authorizations from Sandhills Center for Davidson

Provider Alert: Utilization Management Update: Attention 1915(i) Providers and Tailored Care Management Agencies

Issued: March 1, 2024 Partners Utilization Management (UM) is aware providers have experienced difficulty requesting multiple authorizations for the 1915(i) Community Living and Supports (CLS) service codes. To simplify the process, Partners has created an “ALL” code for these authorizations. What is happening: Partners has created an “ALL” code for 1915(i) CLS so providers can

Provider Alert: Optum-Change Healthcare Cyber Attack

Issued: February 22, 2024 What is happening? Optum-Change Healthcare had a cyber incident late yesterday (Wednesday, Feb. 21, 2024) that has affected health plans nationwide. Due to the large number of customers who utilize Optum-Change solutions, this incident is impacting almost every aspect of healthcare, including Medicaid. Partners, along with other LME/MCOs and Standard Plans,

Provider Alert: NC CORE Individual Placement and Support – Supported Employment (NC CORE IPS-SE)

Issued: February 20, 2024 Effective Monday, February 19, 2024, prior authorization is no longer required for NC Medicaid Direct NC CORE IPS-SE. The NC Core Payment Model: Effective February 19, 2024, outlines all required documentation needed for the service. For information on NC CORE IPS-SE benefit limits, please refer to the State-funded Individual Placement &

Provider Alert: Change to Utilization Management Updates from PCB #147: Peer Support Services

Issued: January 24, 2024 Effective Feb. 18, 2024, a prior authorization will be required for Medicaid Direct Peer Support Services. State-funded Peer Support Services will remain unmanaged with no prior approval required. What is changing? A Notification Service Authorization Request (SAR) is required for members who receive 24 units or less per fiscal year. No

Provider Alert: Partners has increased the Family Centered Treatment (FCT) Rate effective 1/1/2024.

Issued: February 6, 2024 Providers should bill the new rates for the FCT codes for dates of service from 1/1/2024 forward. If providers want claims adjudicated at the higher rate and you have already submitted for dates of service starting 1/1/2024, you will need to submit replacement claims at the higher rate. If you submitted

Provider Alert: Attention Davidson County Providers: Rate Information

Issued: February 5, 2024 Partners Health Management will continue to pay claims for Davidson County members at the rate previously paid by Sandhills Center to ensure care continuity for members and provider stability. Beginning on Feb. 1, 2024, services for Partners’ new Davidson County members will be reimbursed at historical Sandhills Center rates. What is