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Provider Communication Bulletin #166

In This Bulletin:

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Follow the Correct Claims Reconsideration Process

Partners Health Management has seen an increase in reconsideration requests being sent to the Provider Dispute email, which can delay processing and resolution.

To ensure timely review and response, providers must follow the Claims Reconsideration Process outlined on the Partners website.

Key reminders:

  • Do not send reconsideration requests to the dispute inbox.
  • Submit requests using the Claims Reconsideration Form available on the Claims and Rates Information page.
  • Follow the steps listed under the “Claims Reconsideration Process” section.

What is Claims Reconsideration?

If a provider is dissatisfied with a claims processing outcome, they may submit a Reconsideration Form. A claims analyst will review the claim for accuracy and issue a research outcome.

If the provider remains dissatisfied after the reconsideration process, they may then choose to file a formal grievance or complaint.

Visit the Claims and Rates Information page to access the form and process steps.

For questions, contact the Claims Department at ClaimsDepartment@PartnersBHM.org.

High-Fidelity Wraparound Update

Effective Aug. 1, 2025, North Carolina Medicaid Direct In Lieu of Service (ILOS) High-Fidelity Wraparound will align with the Tailored Plan and implement a nine-month, pass-through authorization process.

Key changes include:

  • A Notification Service Authorization Request (SAR) must be submitted within one week of service initiation.
  • No medical necessity review is required for the pass-through period.
  • Concurrent authorizations will be required every 60 days and must include:
    • An updated Person-Centered Plan (PCP) or High-Fidelity Wraparound Plan of Care (Phases one through three).
    • A service order signed by a fully licensed or associate licensed clinician.

Additional updates:

  • The eligible age range is expanding from 5 to 20 to ages 3 to 21.
  • A coach/supervisor may now be a masters-level Qualified Professional (QP) or bachelor-level QP credentialed as a High-Fidelity Wraparound facilitator.

Visit the Partners Service Definitions page for more policy information.
For questions, contact the Utilization Management (UM) department at UMQuestions@PartnersBHM.org.

NC-TOPPS Updates

Coming Soon: NC-TOPPS Kudos Corner Webpage

Partners Health Management is excited to announce the upcoming launch of the NC-TOPPS Kudos Corner—a new, centralized webpage designed to support providers in all aspects of NC-TOPPS participation.

Slated for release in the coming weeks, this one-stop destination will offer tools, tips and recognition related to NC-TOPPS requirements—all in an accessible, easy-to-navigate format.

The webpage will feature:

  • Recognition Spotlight – Highlighting providers who meet or exceed expectations for timely NC-TOPPS submission.
  • Featured Topics – Guidance on specific reporting areas, such as Initial Interviews or discharge requirements.
  • Provider Q&A – Answers to common questions about NC-TOPPS processes.
  • Get Support – Direct contact information for the Partners and State NC-TOPPS Help Desks.
  • Tools & Resources – Quick access to forms, training materials and the NC-TOPPS provider guide.

We look forward to spotlighting the great work being done across our network and providing a resource to support your success.

For questions, contact the Partners NC-TOPPS Help Desk at NCTOPPSQuestions@partnersbhm.org.

Stay tuned for launch details in next month’s bulletin.

Introducing the Inclusion Coalition

Partners Health Management invites providers to join the Inclusion Coalition, a provider-led quarterly meeting focused on advancing health equity, improving care quality and reducing disparities across behavioral, physical and pharmacy services.

Formerly known as the DEI Collaborative, the Inclusion Coalition promotes culturally and linguistically appropriate services (CLAS) and supports providers in delivering effective, inclusive care to diverse populations.

The coalition works to develop actionable strategies that help providers better understand and meet the needs of the communities they serve.

Quarterly meetings are open to all providers. To register for upcoming Inclusion Coalition meetings, visit the TRAC Provider Training webpage. For accommodation requests, email Training@PartnersBHM.org.

ProAuth: Common Questions and Support Tips

Partners has received several questions from providers using the ProAuth system. Below are key reminders to help avoid submission errors and ensure timely processing:

Submitting Authorizations

  • Ensure the Provider Filter is active (green circle).
  • Confirm the correct provider and site are selected.
  • Match the service type and diagnosis code to the procedure code (e.g., I/DD with F72 for Innovations).

Browser and Access Issues

  • Use Chrome or Microsoft Edge and disable pop-up blockers.
  • Clear your browser cache if the ProAuth dashboard does not load.
  • For persistent errors, email ProviderConnectSupport@partnersbhm.org with full-screen screenshots.

Uploading Documents

  • Use the “Add Attachment” button on page two of the Service Authorization Request (SAR).
  • Document names must include only letters, numbers, underscores or dashes.
  • Documents cannot be uploaded after submission.

If documents are missed:

New to ProAuth?

For system issues: ProAuth@partnersbhm.org.
For login/access: ProviderCONNECTSupport@partnersbhm.org.

Chronic Condition Management for Members

Partners Health Management now offers short-term Chronic Condition Management Programs to eligible members with asthma or diabetes. These six- to seven-week programs are opt-in and delivered by a health coach in coordination with the member’s Tailored Care Manager.

These programs are designed to support members in achieving better self-management, improving health outcomes and reducing preventable hospitalizations. They do not replace Tailored Care Management (TCM) but complement it with focused, time-limited education and coaching.

Referring eligible members to these programs can enhance engagement in care and contribute to improved performance on quality measures related to chronic conditions.

To refer a member or learn more, visit the Prevention and Population Health page on our website.

New Staff Development Opportunity: NAMI Provider Program

Partners is pleased to share a new training opportunity from the National Alliance on Mental Illness (NAMI). The NAMI Provider Program is a free, evidence-based seminar designed to help health care professionals and staff better understand the lived experience of individuals affected by mental illness.

Developed for all levels of staff—clinical, administrative and operational—the four-hour program combines medical and recovery models to promote compassionate, collaborative care. It is led by a unique team of three instructors, each with lived experience: a person in recovery, a family member and a mental health professional.

Participants will gain deeper empathy for members, improve communication with families and reduce bias and stigma in care delivery.

Continuing education credits are available. To schedule a seminar or learn more, contact NAMI NC at mail@naminc.org or call 919-788-0801.

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.

Read the full requirements and access trainings here.

Claims Information

Note to Providers: Partners has observed an increase in claims status inquiries from clearinghouses. Providers using a clearinghouse for claim reconciliation must ensure that their staff have access to remittance advice.

Explanation of Benefits (EOB) Requests for Coordination of Benefits Claims

Partners requests copies of the Explanation of Benefits consumers/claims submitted with Coordination of Benefits. The request will be sent via email from Partners Claims staff.

  • Once requested, please submit the information via secured email prior to the date specified in the request.
  • If a response is not received, the original claim payment will be recouped.

Claims Submission Reminders

  • Each benefit plan must be submitted on separate claims.
  • Ensure all diagnosis codes are included in claims. To help Partners measure member health, identify areas of risk and evaluate the quality of care.
  • Physical Health Paper Claims – mail to
    Partners Health Management
    Attn: Claims
    PO Box 8002
    Farmington, MO 63640-8002

Physical Health Claims Processing

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

  • This change took effect July 1, 2024.
  • Providers can now access Availity® in ProviderCONNECT under the “Physical Health Claims” Quick Links box.

Follow the Correct Claims Reconsideration Process

To ensure timely review and response, providers must follow the Claims Reconsideration Process outlined on the Partners website.

Key reminders:

  • Do not send reconsideration requests to the dispute inbox.
  • Submit requests using the Claims Reconsideration Form available on the Claims and Rates Information page.
  • Follow the steps listed under the “Claims Reconsideration Process” section.
  • Visit the Claims and Rates Information page to access the form and process steps.

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

Member/Recipient Eligibility and Enrollment

For eligibility and enrollment questions, providers are encouraged to contact the Eligibility and Enrollment Department at eligibilityenrollment@partnersbhm.org.

To request enrollment, providers should visit Alpha+ Home Page > Enrollments. For guidance, refer to University > Provider Portal Handbook > Enrollments.

If additional enrollment training is needed, email eligibilityenrollment@partnersbhm.org to schedule one-on-one training. Please note that providers will need to have Microsoft Teams screen sharing capabilities for more specific and in-depth training.

Recent Provider Alerts

July 1, 2025: Utilization Management Update: Transitional Youth Services (TYS) In-Lieu of Service

June 10, 2025: Medicare Crossover Claims

June 9, 2025: Changes to the Healthy Opportunities Pilot due to Changes in Funding Availability

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.

Live Virtual Provider Trainings

To view the currently available training courses and register, visit the TRAC Provider Training webpage. 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 LGBTQ+ individuals and promote affirming environments.
  • CBT Learning Community
    Join us for live, virtual 90-minute trainings on the third Wednesday of each month, now featuring rotating topics that strengthen Cognitive Behavioral Therapy (CBT) skills, support self-care and improve quality of care. Training topics include Core Principles of Dialectical Behavioral Therapy (DBT), Core Principles Acceptance and Commitment Therapy (ACT), Core Principles of Trauma Informed Care and Seeking Safety, Core Principles of Mindfulness, Motivational Interviewing (MI) for Substance Use Behaviors and MI for Holistic Health and Well-being. These practical, evidence-based sessions are ideal for busy professionals.
  • 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.

Live Virtual Provider Collaboratives and Meetings

To view the currently available training courses and register, visit the TRAC Provider Training webpage. Email Training@PartnersBHM.org for accommodation requests.

  • Autism Services Learning Collaborative
    Engage with Utilization Management to discuss service updates and essential information.
  • 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.
  • I/DD Breakout Meeting (Bi-Monthly)
    This bi-monthly meeting provides updates for contracted Intellectual/Developmental Disabilities (I/DD) providers and is a subgroup of the Partners Provider Council. All I/DD providers are welcome to attend. To submit questions or topics for discussion, please contact your Provider Council representative.
    Note: AI notetaking or recording is not permitted. Meeting presentations are shared with attendees and through the Provider Council after each session. To register, visit Partners’ Training Resource and Collaborative.
  • 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.

On-Demand Behavioral Health Provider Training

  • 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.
  • Peer Support Services (PSS) Service Definition Webinar (42:29)
  • Person Centered Plan (PCP) Documentation Training Apr 2025 (51:20)
  • 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.

 On-Demand Physical Health Provider Training

  • Partners-CCH Physical Health Office Hours April 2025 (1:08:35)
  • Partners-CCH Physical Health Office Hours March 2025 (1:07:24)
  • Partners-CCH Physical Health Office Hours September 2024 (24:34)
    Handout available at registration
  • 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.

ProviderCONNECT On-Demand Trainings

  • ProAuth Demonstration Video April 2024
    The new system requires providers to log in to ProviderCONNECT to submit authorization requests. Since launch, Partners has identified some common questions among providers on how to access or use the system.
  • 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.

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.

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.

Maternal Mental Health
Aug. 6, 2025 | 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.

Darkness to Light
Aug. 7, 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 3-hour training.

Partners Member Café
Aug. 12, 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!

Understanding Grief
Aug. 13, 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 1: Introduction to Trauma and Resilience  
Aug. 14, 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 the effects and develop resilience.

Question, Persuade, Refer (QPR) Suicide Prevention  
Aug. 18, 2025 | 2-4 p.m. (Register)
This evidence-based training teaches the skills to recognize warning clues of suicide and intervene in a suicide crisis. “Ask a question, safe a life.” *The maximum number of people allowed to participate in a virtual QPR training at one time is 30; registration is on a first-come, first-served basis.

Human Trafficking: Keeping Our Children Safe   
Aug. 20, 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 some ideas about how to keep our children safe. This training addresses sexting briefly.

Active Listening/De-Escalation   
Aug. 21, 2025 | 10 a.m. – noon (Register)
This training focuses on active listening skills, empathy, and habits to keep yourself and other people safe. There will be a discussion about how our own experiences impact our ability to assist others in high-stress situations.

Substance Use Disorder: Overview, Recovery and Resources
Aug. 21, 2025 | 2-4 p.m. (Register)
This training provides an overview of substance use disorder, including its effects on mental and physical health, while identifying specific substances and their impacts. Participants will gain valuable insights into recognizing substance-related challenges and accessing helpful resources. Join us to explore practical strategies for supporting individuals impacted by substance use disorder.

Stress Management
Aug. 22, 2025 | 10 a.m. – noon (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.

Mental Health 101
Aug. 25, 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. This training also includes information about treatment and what to do in a crisis.

Community Resiliency Model (CRM)®
Aug. 26 2025 |10 a.m. – noon (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.

Nutritional Impact on Mental Health      
Aug. 26, 2025 | 2-4 p.m. (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.

Partners Community Café     
Aug. 27, 2025 | 10-11 a.m. (Register)
Join us on Aug. 27, 2025, for the Partners Community Café. As schools get back into session, Partners will recognize Don’t Be a Bully Month. Speakers will discuss the issue of bullying and programs that address the problem by teaching young people how to deal with bullying.

Diabetes 101
Aug. 28, 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.

Trauma Part 2: Trauma Informed Care       
Aug. 28, 2025 | 2-4 p.m. (Register)
We will look at how our behavior affects others who have a history of trauma. Learn about the elements of trauma informed care. A childcare specific version is available on request.

Non-Suicidal Self-Injury
Aug. 29, 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.

In-Person Trainings

System of Care Training: An Introduction to Child and Family Teams (CFT): A Cross System Training from the Family’s Perspective (Part 1)
Virtual Training
Aug. 12-13, 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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