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Provider Alert

Provider Alert: Utilization Management Update: Member Specific Rates (Enhanced Rate Requests)

Issued: Nov. 4, 2025 Effective Oct. 1, 2025, Partners Health Management implemented the NC Medicaid Rate Reductions changes made by the Division of Health Benefits (DHB). In conjunction with these changes, Partners has made updates to the criteria for new Member Specific Rate Requests (Enhanced Rate Requests). What is Happening? Effective Nov. 1, 2025, Partners

Update – Provider Rate Reduction Implementation

Issued: October 31, 2025 Earlier this year, the North Carolina Department of Health and Human Services (NCDHHS) requested additional funding from the General Assembly to fully support the state’s Medicaid rebase. The final appropriation from the General Assembly was less than requested, resulting in a funding shortfall. To address this shortfall, NCDHHS developed a plan

Provider Alert: SUD Update, Letter of Support Process for New Waiver Requests, and OTP Waiver Renewals

Issued: October 24, 2025 Partners Health Management is providing updates on NC Medicaid’s Substance Use clinical coverage policies and temporary waiver requests, and information on Opioid Treatment Plan waiver renewals. Clinical coverage policy updates are effective Jan. 1, 2026. SUD Clinical Coverage Policy Updates and Temporary Waiver Requests What is happening? Clinical Coverage Policies NC

CMS-Approved NQTLs: Staggered Implementation Plan and Provider Guidance

Issued: October 8, 2025 Effective Dates: Dec. 1, 2025, and Jan. 1, 2026 This communication provides updates and clarifications for providers and Tailored Care Managers regarding the application of CMS-approved Non-Quantitative Treatment Limitations (NQTLs) to Behavioral Health and Substance Use Disorder services. These changes align with Parity compliance requirements and outline the staggered implementation plan

Partners to Implement Medicaid Rate Reductions in November

Issued: September 30, 2025 The North Carolina Department of Health and Human Services (NCDHHS) announced that provider reimbursement rates for Medicaid-funded services will be reduced beginning Oct. 1, 2025. Partners is delaying implementation until Nov. 1, 2025, to help minimize the immediate impact on providers. Background: Each year, the Medicaid program must be “rebased” to

Reminder: 2025 Perception of Care Survey Closes September 19

Issued: September 2, 2025 The 2025 MH/SUD Client Perceptions of Care Survey closes Sept. 19, 2025. All surveys are required to be submitted electronically via the appropriate link for the member’s population (Adult, Youth, Child/Family). Spanish versions are also available. What is happening? Partners Health Management is requesting providers of mental health and substance use