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Issued: July 26, 2024 What is happening? Partners, through its partnership with Carolina Complete Health, is using Evolent (formerly National Imaging Associates, Inc.) to provide the management and prior authorization of non-emergent, advanced outpatient imaging services. Only non-emergent procedures performed in an outpatient setting rendered on and after October 1, 2024, will require authorization with

    STATE HEALTH PLAN PROGRAM CODES MODIFIER DESCRIPTION EVV is required for the following PCS and CAP service codes effective Jan. 1, 2021 State Plan PCS PCS 99509 HA Any beneficiary under 21 years regardless of setting State Plan PCS PCS 99509 HB In-home care agencies, beneficiary 21 years or older CAP Community Alternatives

Issued: June 28, 2024 Prior Auth Exception Set from July 1 through Sept. 30 To alleviate provider administrative burden during the launch of Tailored Plans on Monday, July 1, 2024, Partners Health Management will initiate a No Prior Auth period for medical services (physical, behavioral health and I/DD services) rendered between July 1, 2024, and Sept.

Partners Health Management and HHAeXchange have announced an update for providers regarding P.O. Box addresses for service location. Electronic Visit Verification (EVV) providers using the HHAeXchange portal should email the Partners EVV support team at EVVSupport@PartnersBHM.org to add or update service location addresses for the member profile in the HHAeXchange portal, as well as update

Effective 7/1/24 EVV- Tailored Plan Physical Health Providers Section 12006 of the Twenty First Century Cures Act (Cures Act) and the Centers for Medicare & Medicaid Services (CMS) requires the State of North Carolina to begin utilizing an Electronic Visit Verification System (EVV) for all the Tailored Plan Programs by July 1, 2024. The Cures

Providers are required to maintain their own agency waiting lists to share with Partners to be added to the network’s waiting list. Providers are expected to notify Partners at least weekly about members that have been added to their provider State-Funds Services (SFS) waiting list. Providers can report their SFS provider waiting lists by completing

Updated: April 6, 2023 Please reference the tables below for changes. Services with no changes for Tailored Plan effective October 1, 2023, or NC Medicaid Direct effective April 1, 2023 (Nothing needed from provider – no code changes) Current in Lieu of Service (ILOS) Name and Code Tailored Plan ILOS effective October 1, 2023 NC