Expiring Transitions of Care PA Flexibilities
Transitions of Care PA Flexibilities introduced during the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan launch will end on Jan. 31, 2025. After this date, members will need new prior authorizations (PAs) as their current ones expire.
Full details on these flexibilities and pharmacy PA tips are in Partners’ Provider Communication Bulletin #158.
Back Up Staffing Flexibilities Ending
To support recovery efforts following Hurricane Helene, all back-up staffing reporting requirements were temporarily waived through Dec. 31, 2024. This flexibility ended on Jan. 1, 2025, and all reporting requirements have resumed.
Providers are reminded that compliance monitoring began in January 2025. Starting in April 2025, providers failing to submit back-up staffing incidents or attestations twice per month will be issued a Plan of Correction (POC).
Partners encourages providers to maintain clear internal records to facilitate the transition back to standard procedures. For questions, email BackupStaffing@PartnersBHM.org for a timely response.
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:
- For virtual IRIS training, register here.
- To schedule an in-person IRIS training, email IRIS@PartnersBHM.org.
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.
Recent Provider Alerts
- Jan. 17, 2025: Remittance Emails Not Received
- Jan. 10, 2025: Guidance on Beneficiaries Enrolled in Medicaid and ACA Marketplace Coverage
- Dec. 31, 2024: UPDATED: Clarification of Clinical Coverage Policy and Hurricane Helene Flexibilities
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 is 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 six 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 (three HIV, three Ethics). - Illness Management and Recovery (IMR)
Develop skills to support recovery and manage mental illness using evidence-based strategies. Approved for six NCSAPPB hours. - Mindfulness and Recovery Training
Discover mindfulness techniques for stress management and recovery in mental health and substance use. Approved for six 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 six 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 six NCSAPPB hours. - Twelve Step Facilitation Training
Review TSF principles, treatment models, and recovery pathways for substance use disorders. Approved for six 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.
Diabetes 101
Feb. 4, 2025, 10 a.m.-noon (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.
Risk and Resilience: Buffering Toxic Stress Modules 1-5
Feb. 4, 2025, 6-8 p.m. (Register)
- Risk and Resilience: Buffering Toxic Stress Modules 1-3 This introductory training provides information about how early childhood stress and trauma can result in negative lifelong outcomes in learning, behavior and health. We discuss interventions to buffer the impact of toxic stress.
- Risk and Resilience: Buffering Toxic Stress Modules 4-5) This is a follow-up to Modules 1-3. Module 4, Limbic Calming, teaches how to help children calm their limbic systems. In Module 5, Cortical Coping, we will learn about healing the cortical brain to develop active coping skills such as impulse control and problem solving.
Darkness to Light
Feb. 6, 2025, 9 a.m.-noon (Register)
The Darkness to Light training provides education about child sexual abuse and the steps you can take to prevent, recognize and react responsibly to child sexual abuse; participants learn proactive steps to protect children from this significant risk. This is a three-hour training.
Domestic Violence: How to Help
Feb. 6, 2025, 2-4 p.m. (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.
Human Trafficking: Keeping Our Children Safe
Feb. 7, 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.
Partners 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 the resources and services you need and who to call. We look forward to seeing you!
Active Listening/De-escalation
Feb. 11, 2025, 2-4 p.m. (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.
Community Resilience Model®
Feb. 13, 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.
Mental Health 101
Feb. 18, 2025, 2-4 p.m. (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.
Question Persuade Refer (QPR) Suicide Prevention
Feb. 19, 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.”
Maternal Mental Health
Feb. 20, 2024, 10 a.m.-noon (Register)
This training delves into the nuances of maternal mental health, perinatal mood disorders and practical tools for support. Explore the essential intersection of mental health, pregnancy/postpartum care and social determinants of health while gaining insights that contribute to creating a nurturing environment for mothers.
Trauma Part One: Introduction to Trauma and Resilience
Feb. 20, 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.
Non-Suicidal Self Injury
Feb. 25, 2025, 10 a.m.-noon (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.
Stress Management
Feb. 25, 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
Feb. 26, 2025, 10-11 a.m. (Register)
The February Community Cafe will celebrate Cancer Prevention Month. Speakers include a cancer survivor who will share her story of recovery and experts on prevention and finding support through community.
Understanding Grief
Feb. 27, 2025, 10 a.m.-noon (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.
Trauma Part Two: Trauma Informed Care
Feb. 27, 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.
Nutritional Impact on Mental Health
Feb. 28, 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.
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)
April 15-16, 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.