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Provider Communication Bulletin #159

In This Bulletin:

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Holiday Closing Announcement

Partners Health Management offices will be closed on the following dates for the holidays:

  • Tuesday, Dec. 24 – Thursday, Dec. 26, 2024 (Christmas Eve, Christmas Day, day after Christmas)
  • Wednesday, Jan. 1, 2025 (New Year’s Day)

Regular operations will resume on Friday, Dec. 27, 2024, and Thursday, Jan. 2, 2025, respectively.

If you or someone you know is experiencing a non-medical emergency during this time, help is available. Please call our Crisis Help Line at 1-833-353-2093 for immediate assistance. Our team is available to help 24 hours a day, every day.

We wish you a safe and joyous holiday season!

Residential Providers Survey

At Partners, we are committed to continuously improving our services by gathering feedback from our providers. We are seeking your insights specifically regarding child/adolescent residential services.

The information collected through this survey will guide the development of enhanced information-sharing practices and outreach strategies, ensuring that members have access to necessary child/adolescent residential services.

We appreciate your time and effort in completing this survey. Please submit your responses by Jan. 3, 2025.

Survey Link: https://www.surveymonkey.com/r/68Z2WN3

SUD Treatment Providers Needed for Pregnant and Postpartum Women

Partners issued a modified Request for Proposal (RFP) – RFP #1124-001 – to identify a substance use disorder (SUD) treatment program provider for pregnant and postpartum women within its 15-county region.

The RFP submission deadline is Jan. 10, 2025.

Click here to read the full RFP announcement. FAQs are available now.

Send additional questions to PNDevelopment@PartnersBHM.org.

Current Service Needs

Partners has identified the following needs in its provider service network:

Clinically Managed Residential Withdrawal Services is a facility-based service with 24-hour supervision, support and peer-driven care for individuals experiencing moderate withdrawal symptoms. A physician available around the clock oversees clinical protocols to ensure safe and comfortable withdrawal from alcohol and other substances, facilitating the transition to ongoing treatment and recovery. Providers are needed across the Partners 15-county service area.

Multidisciplinary Evaluation (MDE) is a comprehensive assessment ordered by the clerk of court to identify an individual’s competency in guardianship proceedings. It includes current medical, psychological and social work evaluations and may involve professionals from other disciplines such as education, vocational rehabilitation and psychiatry. Qualified providers conduct the evaluations, covering various aspects of the respondent’s cognitive and functional capacity. Providers are needed across the Partners 15-county service area.

Partial Hospitalization for adult/child-adolescent (PH) is a short-term service for acutely mentally ill individuals, offering a wide range of intensive therapeutic approaches such as group and individual therapy, recreational activities, community living skills training and medical services. It is designed to prevent hospitalization or serve as a step for those leaving an inpatient facility with physician involvement distinguishing it from Day Treatment Services. Providers are needed within Iredell County for NC Medicaid Direct.

Outpatient Opioid Treatment is a service that uses methadone or other Food and Drug Administration (FDA)-approved drugs alongside rehabilitation and medical services to help individuals with opioid addiction. It is a tool in the detoxification and rehabilitation process and may be billed to provide maintenance or detoxification services for those diagnosed with opioid use disorder. Providers are needed in Union County for NC Medicaid Direct and Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan.

Cognitive Rehabilitation (Traumatic Brain Injury [TBI] Waiver) is an individual therapy to develop thinking skills to improve functional abilities, including attention, memory and problem-solving and to help spot impaired thinking. Providers are needed across the Partners 15-county service area for NC Medicaid Direct and Tailored Plan.

Non-Hospital Medical Detoxification provides 24-hour medically supervised evaluation and withdrawal management with medical and nursing professionals. This service is offered in permanent facilities, either hospital-connected or freestanding with 16 beds or fewer. Providers must coordinate with Partners for state-funded services and obtain necessary service orders. Providers are needed across the Partners 15-county service area for NC Medicaid Direct and Tailored Plan.

Ambulatory Withdrawal Management Without Extended On-Site Monitoring (Ambulatory Withdrawal) is an outpatient service offering medically supervised evaluation, withdrawal management and referral, provided in structured sessions and medical protocols. Providers are needed across the Partners 15-county service area for State-funded adult members.

Substance Abuse Medically Monitored Community Residential Treatment (MMCRT) is a 24/7 non-hospital rehabilitation for adults with substance used disorders, offering evaluation, care and treatment for the restoring function. Providers are needed across the Partners 15-county service area for NC Medicaid Direct and Tailored Plan adult members.

For more information and next steps to provide any of the above Service Needs, visit Partners’ Current Service Needs Page. To learn more about these opportunities, email PNDevelopment@PartnersBHM.org.

PCP Member Choice Update

Partners is committed to providing members with the best possible Primary Care Provider (PCP) choices. However, members may sometimes be unable to select their preferred PCP due to panel limits.

A “panel limit” refers to the maximum number of members a physician can manage in their practice. This limit is determined by factors such as the physician’s available time, the complexity of members’ needs and the practice’s capacity to ensure quality care. Maintaining an appropriate panel size is essential to provide adequate attention, prevent burnout and improve care quality.

If a provider’s panel limit is reached and we cannot confirm the member’s established relationship with that provider, documentation is required to assign the member to the PCP. Providers must submit a letter on office letterhead, including the member’s name, date of birth, Medicaid ID and confirmation of either an established relationship or acceptance of the member. Alternatively, we can accept claims history showing at least six months of primary care treatment.

Documentation should be sent by email to PCP@PartnersBHM.org or by fax to 704-884-2736 (Attention: Member PCP Choice).

For questions, contact Renee Jenkins, Member Engagement Support Specialist, at 704-842-6488.

IRIS Incident Reporting Reminders

All providers of publicly funded services are required to submit Level II and Level III incident reports in the North Carolina Incident Response Improvement Center (IRIS) within 72 hours of becoming aware of the event. This applies to:

  • Category A Providers: Providers of publicly funded services licensed under NC General Statutes 122C, except hospitals.
  • Category B Providers: Providers of publicly funded non-licensed periodic or community-based mental health, developmentally disabled and/or substance abuse services.

Key Requirements:

  • Timely Reporting: Level II and Level III incidents must be reported in IRIS within 72 hours of discovering the incident.
  • Immediate Notification for Level III Incidents: Level III incidents must be reported to Partners immediately. For Partners members, notifications can be sent to IRIS@PartnersBHM.org.
  • Accurate Demographic Information:
    Ensure all demographic details are complete and accurate, including:
    • Correct spelling of the member’s name
    • Date of birth
    • Host Local Management Entity/Managed Care Organization (LME/MCO) county (county where services are provided)
    • Home county (county where the member’s Medicaid originates)
    • Member’s LME/MCO number
    • Client Record Number
    • CNDS ID
    • Medicaid ID
  • Documentation Submission: Submit all requested documentation within five business days from the date of the request.
  • Provider Contact Information: Provide the name, phone number and email address of the appropriate staff or supervisor in all IRIS reports to allow Partners to reach you if needed.
  • Daily IRIS Report Follow-Up: Check your submitted IRIS reports daily for any comments, follow-up requests or documentation needs from Partners.

Additional Resources:

Claims Information

Providers are reminded to contact the Claims Department at ClaimsDepartment@PartnersBHM.org for all claims related questions. To avoid delays in receiving a response, please do not contact individual claims staff directly.

Explanation of Benefits requests for Coordination of Benefits Claims

As a reminder, Partners does request copies of the Explanation of Benefits for claims submitted indicating Coordination of Benefits. The request will originate via email from Partners Claims staff. Once requested, please submit the information via secured email prior to the date indicated in the emailed request. If a response is not received, the original claim payment will be recouped.

Reminder: Taxonomy Code 193200000X and 193400000X: Taxonomy Code 193200000X and 193400000X should not be submitted on claims as the rendering taxonomy code. All claims submitted with this taxonomy code as the rendering code will be reverted.

Reminder: Please remember to include all diagnosis codes on claims. This allows Partners to measure member health, identify areas of risk and evaluate the quality of care.

Member/Recipient Eligibility and Enrollment

Providers are encouraged to contact the Eligibility and Enrollment Department at EligibilityEnrollment@PartnersBHM.org for eligibility and enrollment related questions.

To request an enrollment, providers should go to Alpha+ Home Page>Enrollments. University is an available resource for providers as a basic guide for navigating enrollments. For more information, go to University>Provider Portal Handbook>Enrollments.

If additional enrollment training is needed, email EligibilityEnrollment@PartnersBHM.org to schedule one-on-one training. Note that providers will need Microsoft Teams screen sharing capabilities for more provider specific and in-depth training.

Physical Health Claims

Partners Health Management has partnered with Availity®, an independent company, to operate and service our electronic data interchange (EDI) and portal transactions with Carolina Complete Health for Physical Health Claims processing.

The change took place July 1, 2024.

Availity® can now be found in ProviderCONNECT called “Physical Health Claims” under the Quick Links box.

Reminder: Mail Physical Health paper claims to:

Partners Health Management
Attn: Claims
PO Box 8002
Farmington, MO 63640-8002.

Utilization Management Updates

Medicaid Direct 1915(b)(3) Services Ending Dec. 31, 2024

As announced in Partners’ Provider Communication Bulletin #156, the North Carolina Department of Health and Human Services (NCDHHS) will end its authority to offer 1915(b)(3) services under the 1915(b) waiver effective Dec. 31, 2024.

Starting that date, Partners will no longer authorize 1915(b)(3) services for Medicaid Direct members. Members currently receiving these services must transition to 1915(i) services or another appropriate alternative by Dec. 31, 2024.

To ensure compliance:

  • Utilization Management (UM) will adjust any 1915(b)(3) service authorizations with end dates beyond Dec. 31, 2024, to align with this cutoff.
  • All 1915(b)(3) service codes will be retired as of this date.

For more information, please review Provider Communication Bulletin #156 or contact UMQuestions@PartnersBHM.org.

Quality Management Updates

UPDATE: UAFL On-Site Review Requirements

The Partners Unlicensed Alternative Family Living (UAFL) On-Site Review Form is no longer required. The form may be used as a resource tool to assist providers without an existing tracking form in preparing for initial or annual UAFL reviews. This change aims to support providers in achieving successful Quality Management (QM) monitoring outcomes.

Previously, Communication Bulletin #158 stated that provider agencies must complete the form before their reviews to ensure compliance and maintain safety and quality in UAFL homes. However, feedback received during the Nov. 22, 2024, Provider Council meeting led to the removal of this requirement.

For more details, learn more about UAFL reviews here, or contact the Quality Management Monitoring team at QMMS@PartnersBHM.org.

Recent Provider Alerts

State News and Updates

NCDHHS Resources:

  • Joint Communication Bulletins, which are issued by the N.C. Department of Health and Human Services, can be found here.
  • Medicaid Bulletins: All bulletin articles are available here. Providers are encouraged to frequently review this information.
  • Medicaid Pharmacy Newsletters are available here.
  • NCTracks: Providers are encouraged to review NCTracks communications. To subscribe to NCTracks communications, click here.

Training Resource and Collaborative (TRAC)

TRAC offers a centralized cross-functional selection of required training, collaboratives and events. TRAC provides a centralized hub for cross-functional required training, collaboratives and events.

Please note: the way you register for TRAC trainings and meetings has recently changed.

CLICK HERE TO VIEW WHAT’S COMING UP AND REGISTER.

Monthly and Quarterly Meetings

To view meeting times and register, please visit PartnersTraining.org. Email Training@PartnersBHM.org for accommodation requests.

  • Autism Services Learning Collaborative
    Engage with Utilization Management to discuss service updates and essential information.
  • CBT Learning Community (Monthly Meeting)
    Join a community of providers to explore skills, concepts, case studies, and expand techniques for using evidence-based practices. Earn 1.5 CE credits while enhancing your professional growth and improving care quality.
  • Global Continuous Quality Improvement Meeting
    Collaborate with providers, the Provider Advisory Council, and stakeholders to develop quality improvement strategies and measurable outcomes that enhance integrated health services and care quality.
  • Long Term Community Supports (LTCS) Collaborative
    Discuss the implementation of Medicaid In-Lieu of Service – Long Term Community Supports (LTCS), address barriers to service access, and ensure service continuity and quality for members.
  • Partners Provider Forum
    Stay updated with quarterly vital information and updates tailored for providers.
  • Provider DEI Collaborative
    Engage in discussions on diversity, equity, and inclusion (DEI) to promote health equity and improve outcomes. Providers’ perspectives are vital for fostering actionable strategies for integrated care.
  • Provider Open House
    A quarterly virtual event for new and existing providers to address questions and receive support, including one-on-one training opportunities. Providers with state funding contracts are encouraged to attend.

Live Virtual Trainings

To view the currently available trainings and register, visit PartnersTraining.org. Email Training@PartnersBHM.org for accommodation requests.

  • Acceptance and Commitment Therapy (ACT)
    Explore ACT’s six core processes for developing psychological flexibility and using the ACT Matrix to help clients value-driven action. This training is NCSAPPB approved for 6 hours.
  • Becoming an Ally for LGBTQ Clients
    Gain knowledge and strategies to effectively support LGBTQIA2S+ individuals and promote affirming environments.
  • Connecting Community Support Team and Permanent Supportive Housing (CST-PSH) Training
    Learn the CST-PSH evidence-based model for tenancy support services. This training fulfills NC Service Definition requirements for 15 hours.
  • Dialectical Behavior Therapy (DBT) for Complex Cases
    Understand and apply DBT techniques to treat complex mental health cases. Approved for 6 NCSAPPB hours.
  • HIV & Ethics
    Stay updated on HIV diagnosis and treatment trends while exploring ethical decision-making and social determinants of health. Approved for 6 NCSAPPB hours (3 HIV, 3 Ethics).
  • Illness Management and Recovery (IMR)
    Develop skills to support recovery and manage mental illness using evidence-based strategies. Approved for 6 NCSAPPB hours.
  • Mindfulness and Recovery Training
    Discover mindfulness techniques for stress management and recovery in mental health and substance use. Approved for 6 NCSAPPB hours.
  • Motivational Interviewing Training
    Learn the fundamentals of Motivational Interviewing (MI) to support client behavior change. This 13-hour training meets NC Service Definition requirements.
  • NCSNAP Training
    For forms, schedules, and instructions, email Training@PartnersBHM.org.
  • Person Centered Thinking (PCT) 3-Day Training
    Engage in interactive exercises and discussions to support people with disabilities. Approved for 12 contact hours.
  • Trauma Informed Care and Seeking Safety
    Learn principles of trauma-informed care and the Seeking Safety program for addressing trauma and substance use. Approved for 6 NCSAPPB hours.
  • Trauma Informed Interventions for People Who Support I/DD Members
    Explore trauma’s impact on individuals with IDD and learn trauma-informed strategies.
  • Treating SUD During the Modern Opioid Epidemic
    Examine the opioid epidemic’s scope and explore evidence-based treatments, including medication and CBT. Approved for 6 NCSAPPB hours.
  • Twelve Step Facilitation Training
    Review TSF principles, treatment models, and recovery pathways for substance use disorders. Approved for 6 NCSAPPB hours.

Tailored Plan Provider On-Demand Trainings

The North Carolina Department of Health and Human Services (NCDHHS) requires the listed training courses to be available for providers. This applies to Tailored Plan, Medicaid Direct and State-funded providers. Registering is easy. You will be prompted to enter simple registration information. The on-demand training will then be available immediately or when your schedule allows. Note: Training Reciprocity Among Tailored Plans. NCDHHS is allowing the six LME/MCOs reciprocity for some Tailored Plan-required training courses.

All on-demand training courses can be accessed through PartnersTraining.org.

  • CLAS Standards (35:55)
    Reviews culturally and linguistically appropriate services (CLAS) standards for health equity and cultural competence. No CE credits available.
  • Due Process (33:07)
    Covers four dispute types: Medicaid appeals, non-Medicaid appeals, Provider disputes, and Grievances. No CE credits available.
  • EPSDT (18:26)
    Explores EPSDT requirements, periodicity schedules, diagnostic/treatment components, and service coordination. No CE credits available.
  • Fraud, Waste, and Abuse (20:47)
    Overview of compliance, regulatory programs, and the impact of fraud, waste, and abuse on healthcare. No CE credits available.
  • Into the Mouths of Babes (4:10)
    Focuses on oral health services for Medicaid-insured children. Required for reimbursement eligibility. No CE credits available.
  • Hand Washing & PPE (12:40)
    Infection control training emphasizing handwashing and personal protective equipment (PPE). No CE credits available.
  • Infection Control: Community Care Settings (8:53)
    Focus on infection transmission, precautions, and member education in community care. No CE credits available.
  • Infection Control: Home Care Settings (9:55)
    Highlights infection control procedures in home care settings. No CE credits available.
  • Prevention & Population Health Management (18:52)
    Discusses Partners’ health improvement approach, program goals and provider expectations. No CE credits available.

Provider On-Demand Trainings

  • 1915(i) State Plan Amendment Training (1:09:45)
    Overview of 1915(i) services. Includes Q&A.
  • Client-Specific Training Webinar (June 2024)
    Topic-specific training for providers.
  • Crisis Response Training (3 hours)
    Comprehensive guide to crisis intervention strategies. Contact hours available.
  • Critical Incident Reporting (CIRT/IRIS) (15:20)
    Training on incident reporting procedures.
  • Community Support Team (CST) Service Definition (3 hours)
    Behavioral health support for severe mental illness. Meets CST Service Definition requirements. Three contact hours available.
  • Employer of Record Webinar (27:37)
    Covers EOR monitoring, documentation, and quality management. No CE credits available.
  • Enhanced Rate Request Webinar (25:58)
    Step-by-step ERR form completion and cost finding instructions. No CE credits available.
  • Health Disparities: A Tribal Perspective (29:12)
    Explores health disparities among tribal populations and Medicaid’s role. No CE credits available.
  • Plan of Correction Webinar 2024 (10:16)
    Training on crafting effective plans of correction.
  • Tobacco-Free Recovery (4:45)
    Encourages tobacco-free practices for better health outcomes.

ProviderCONNECT Trainings

  • User Navigation Guide Video
    Introduction to ProviderCONNECT portal features.
  • LA Non-Utilizer Report Video
    Guides administrators on maintaining user accounts.
  • Secure Messages Video
    Instructions on secure communication via ProviderCONNECT.
  • Document Manager Video
    Guide to using the Document Manager for file sharing and management.
  • SysAid2 Service Ticket Overview Video (8 minutes)
    Overview of the service ticket system.

Physical Health Provider Trainings

  • June 2024 Tailored Plan EVV Info Session (11:32)
    Covers Electronic Visit Verification requirements. Includes FAQ.
  • May 2024 Physical Health Providers Update (40:36)
    Updates on tailored plans and care management. Includes FAQ.
  • March 2024 Physical Health Providers Update (56:31)
    Collaboration strategies between providers and Partners Health Management.

Community Training

All Trainings are Virtual via Zoom and are two hours unless otherwise specified. Participants may not be admitted to the training if joining more than 15 minutes after training begins. Participants who request a certificate will need to be on-camera during the training.

For more information contact: Amber Matthews, AMatthews@PartnersBHM.org.

Understanding Grief
Jan. 6, 2025, 2-4 p.m. (Register)
Are you experiencing grief or do you know someone who is grieving? In this training, you will learn about the various causes, phases and other information related to the grieving process.

Nutritional Impact on Mental Health
Jan. 7, 2025, 10 a.m.-noon (Register)
Join us for an insightful training on the intricate relationship between eating behaviors and mental health. This interactive training will explore how our dietary choices and habits can profoundly influence our mental well-being, emphasizing the crucial connection between nutrition and mental health.

Trauma Part One: Introduction to Trauma and Resilience
Jan. 7, 2025, 2-4 p.m. (Register)
Most of us have experienced trauma at some time. This can have a lasting effect on our learning, behavior and health. Learn about trauma, how to address its effects and develop resilience.

Active Listening/De-escalation
Jan. 9, 2025, 10 a.m.-noon (Register)
If you have ever been in a high stress situation where you did not know what to say or how to help, this is the training for you. Active Listening/De-escalation focuses on active listening skills, empathy and habits to keep yourself and other people safe.

Diabetes 101
Jan. 9, 2025, 2-4 p.m. (Register)
The Diabetes 101 training provides a comprehensive overview of diabetes, including its types, signs, symptoms, risk factors and potential complications. Participants will gain knowledge about diabetes prevention, self-management strategies and valuable resources to support those affected by the condition.

Question Persuade Refer (QPR) Suicide Prevention
Jan. 10, 2025, 10 a.m.-noon. (Register)
Jan. 22, 2025, 2-4 p.m. (Register)
This evidence-based training teaches the skills to recognize warning signs of suicide and intervene in a suicide crisis. “Ask a question, save a life.”

Trauma Part Two: Trauma Informed Care
Jan. 13, 2025, 2-4 p.m. (Register)
We will look at how our behavior affects others who have a history of trauma and learn about the elements of trauma informed care. Childcare setting specific version is available upon request.

Human Trafficking: Keeping Our Children Safe
Jan. 15, 2025, 10 a.m.-noon (Register)
Human Trafficking is a global problem, even in the United States. Children may be susceptible to online predators. Learn about trafficking around the world and resources to keep our children safe.

Domestic Violence: How to Help
Jan. 16, 2025, 10 a.m.-noon (Register)
Many of us are still at home more than usual and the risk for domestic violence is high. Learn how to spot the warning signs of domestic violence and how to help someone in a violent situation.

Community Resilience Model®
Jan. 16, 2025, 2-4 p.m. (Register)
The Community Resilience Model® (CRM) teaches participants about the impact of trauma and chronic stress on the nervous system, behavior, and long-term health. Participants learn how to reset the nervous system with easy to learn, concrete coping skills. One of the goals of CRM is to create trauma-informed and resilient communities.

Stress Management
Jan. 21, 2025, 2-4 p.m. (Register)
We’re all stressed! Many of us are balancing jobs, school, family, finances and more. Let’s get together and talk about ways we can manage our stress and have a little fun.

Partners Community Café
Jan. 22, 2025, 10-11 a.m. (Register)
Grab a cup of coffee, sit down and join us virtually to get to know us and learn how we can help you. Ask us questions about the resources and services you need and who to call.

Mental Health 101
Jan. 24, 2025, 10 a.m.-noon (Register)
Learn about mental wellness, potential signs and symptoms of mental health challenges and some of the common behavioral health disorders. The training also includes information about treatment and what to do in a crisis.

Non-Suicidal Self Injury
Jan. 27, 2025, 2-4 p.m. (Register)
Learn about Non-Suicidal Self-Injury, what causes people to injure themselves, warning indicators and what we can do when we encounter someone who self-injures.

Partners Member Café
There will be no January Member Café.
Feb. 11, 2025, 1-2 p.m. (Register)
Partners Member Café is held the second Tuesday of each month. Grab a cup of coffee, sit down and join us virtually to get to know us and learn how we can help you. Ask us questions about resources and services you need and who to call. We look forward to seeing you!

In-Person Trainings

Virtual System of Care Training: An Introduction to Child and Family Teams (CFT): A Cross System Training from the Family’s Perspective (Part 1)
Jan. 8-9, 2025, 9 a.m.- 4 p.m. (Register)

This System of Care training will be virtual. CFT Part 1 is a two-day experiential training course (when you register, you agree to attend both days) with the goal of providing an overview of Child and Family Team meetings from the family’s perspective. The training seeks to reinforce the idea of “one family, one plan” by addressing CFT through the lens of multiple systems as they affect families in their everyday lives. Agency representatives and parents/family members 18 years old and older are encouraged to attend this training. Sessions must have a minimum of 10 participants. Do not schedule other appointments during this training. For more information, email CETraining@PartnersBHM.org.

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