Issued: November 5, 2024
Partners Health Management is providing clarification for providers and/or Tailored Care Managers regarding specific service flexibilities. You can view the list of flexibilities for behavioral health and for physical health on Partners’ Provider Knowledge Base.
This alert is a follow up to an alert issued on Oct. 14, 2024, by Partners, and guidance published by the North Carolina Department of Health and Human Services (NCDHHS) on Oct. 25, 2024.
What is happening?
This notice clarifies Utilization Management requirements for providers and/or Tailored Care Managers regarding specific service flexibilities as outlined for behavioral health and physical health.
On October 14, 2024 Partners Issued a Provider Alert regarding Hurricane Helene Policy Flexibilities Extended through Dec. 31, 2024.
On October 25, 2024, NCDHHS also published guidance on Retainer Payments for home and Community-Based Service Providers Impacted by Hurricane Helene included here.
What do providers need to do?
Any temporary flexibility that waives prior or concurrent authorization requirements applies exclusively to members and providers affected by Hurricane Helene. Providers must have authorizations in place by Dec. 31, 2024, for services rendered on or after Jan. 1, 2025 to avoid service interruptions.
Providers are not required to obtain prior authorization for services rendered via telehealth (GT modifier) or telephonic (KX modifier) as outlined in the charts on Provider Knowledge Base. Please see the charts regarding all other service flexibilities related to authorization requirements.
The modifiers/codes for the flexibilities listed in the charges for behavioral health and physical health are being added into the system and into contracts automatically, so providers are not required to submit a Provider Change Form to add these additional modifiers/codes. Partners anticipates this to be complete by no later than Nov. 8, 2024.
Who can providers call if they have questions?
Providers should read the bulletins for complete information on the flexibilities:
If providers have questions, they can:
- Contact their account specialist or email PAS@PartnersBHM.org (behavioral health) or PHPAS@PartnersBHM.org (physical health)
- Call the Provider Services Line at 1-877-398-4145
- Email UMQuestions@PartnersBHM.org (behavioral health) or PHUMQuestions@PartnersBHM.org (physical health)
- Call Partners Pharmacy line at 1-866-453-7196 with pharmacy questions