Issued: March 6, 2025
As of Jan. 1, 2025, Partners Health Management began requiring Tailored Care Managers to submit a Notification Service Authorization Request (SAR) in ProAuth/TruCare for the Electronic Visit Verification (EVV) Service, 1915(i) Individual and Transitional Support (ITS).
TCMs may submit retroactive SARS back to Jan. 1, 2025.
What is happening?
To ensure claims are paid, Partners is requiring TCMs to submit Notification SARS in ProAuth/TruCare for EVV 1915(i) Individual and Transitional Support:
- This applies to 1915(i) ITS – T1019 U4.
- A medical necessity review is not required for a Notification SAR.
- SAR submission for non-EVV 1915(i) ITS – T1019 U4 TS is not
- TCMs may submit retroactive SARs back to Jan. 1, 2025.
- The 1915(i) Independent Evaluation Eligibility must be met. A 1915(i) Assessment and Care Plan/PCP are required and should be submitted with the SAR.
- A typical request is up to 60 hours (240 units) or less per month for up to 1 year. (1 unit = 15 minutes).
What do providers need to do?
Providers need to maintain clinical documentation required by Clinical Coverage Policy 8H-3 1915(i) ITS in the member’s medical record to include:
- Care Plan/PCP
- Service Order (qualified professional, licensed psychologist, licensed behavioral health clinician, physician, nurse practitioner or physician assistant)
- 1915(i) Assessment
- Updated Care Plan/PCP and updated signature page
Providers should also continue to bill 1915(i) ITS through HHAExchange.
Who can providers contact if they have questions?
If providers have questions, they can:
- Email UMQuestions@PartnersBHM.org (behavioral health) or PHUMQuestions@PartnersBHM.org (physical health)
- Email Tailored Care Management: TCM_CSS@partnersbhm.org