Partners works with a number of hospitals to provide inpatient services for enrollees. This section contains information for hospital providers.
Hospitals interested in joining the Partners Network should email Providers@PartnersBHM.org.
Partners requires prior authorization for inpatient admissions. Hospitals seeking to admit a Partners’ enrollee for inpatient psychiatric treatment should call the UM Hospital Admissions Team at 704-842-6434. Staff is available 9 to 7 p.m., seven days a week.
Details regarding authorization can be located in the Partners’ Provider Operations Manual.
░ Quick Links: |
Inpatient Document/Form Information Grid
| Document Information | Frequency of Submission | Forms and Document Links | How to Submit to Partners |
|---|---|---|---|
| Out of Network Hospital Single Client Inpatient Application/ Agreement
This document serves as the contractual agreement for the inpatient services. |
Each admission/episode of care per enrollee | Out of Network Hospital Single Client Inpatient Agreement | Send via Secure email to providers@partnersbhm.org |
| Inpatient Review Form | At admission and per benefit plan limits until discharged | Inpatient Review Form | Send via Secure email to providers@partnersbhm.org
OR Information can be given via telephone interview with UM reviewers at 704-842-6434 7 days per week 8 a.m.-7 p.m. |
| Manual Service Authorization Request (SAR) | Submit only if advised by the ProAuth Team. | See full instructions on the Service Authorization Requests (SAR) page. | Call Partners IT:
Normal Business Hours: 704-842-6431 |
| Copy of Certificate of insurance for General & professional liability, automobile coverage as applicable, workers comp | Each admission/episode of care per recipient. Should cover the dates of service of the admission | N/A | Send via Secure email to providers@partnersbhm.org |
| Hospital-Based Clinician Registration Worksheet | Each Admission/episode of care per recipient if attending physician services are billed as part of inpatient services by hospital | Hospital-Based Clinician Registration Worksheet | Send via Secure email to providers@partnersbhm.org |
| Trading Partners Agreement – Used only if filing claims using HIPAA compliant transactions. | Submitted one (1) time and kept on file unless there are changes. If already submitted for other services such as Emergency Department services, does not have to be submitted again unless there are changes. | Trading Partner Agreement
OR Will be mailed by Finance staff with fully executed out of network agreement for the facility’s first agreement submitted |
Send via Secure email to providers@partnersbhm.org
OR Mail to: |
| W-9 | Each admission/episode of care | N/A |