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Provider Communication Bulletin #170

In This Bulletin:

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Thanksgiving Office Closure

Partners Health Management offices will be closed on Thursday, Nov. 27, and Friday, Nov. 28, in observance of the Thanksgiving holiday.

Our Behavioral Health Crisis Line remains available at 1-833-353-2093 to support members 24/7/365.

Clozapine Management Education Resource

To support provider education on clozapine management, Partners is sharing a free, on-demand training series developed by the Schizophrenia & Psychosis Action Alliance (S&PAA) in collaboration with the American Association of Psychiatric Pharmacists (AAPP).

A New Era in Clozapine Management includes seven accredited modules that help providers:

  • Strengthen skills in clozapine initiation, monitoring and managing adverse effects
  • Address needs for special populations
  • Incorporate patient perspectives
  • Use evidence-based strategies to improve outcomes

Providers can choose individual modules or complete the full series at their own pace. All courses are available at no cost through AAPP.

Curriculum information: https://sczaction.org/clozapine-curriculum

Registration: https://aapp.org/ed/clozapine2025

Current Service Needs

After completing the October 2025 Network Adequacy review, Partners seeks providers across our 15-county service area.

Priority Service Gap

Ambulatory Withdrawal Management (Adult): Ambulatory withdrawal management with extended on-site monitoring for adults includes medically supervised evaluation, withdrawal management and referral support, following structured protocols. This service is needed for NC Medicaid Direct and Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plan.

Ongoing Needs

  • Multidisciplinary Evaluation (MDE) Court-ordered, comprehensive assessments for guardianship proceedings (medical, psychological, social work; other disciplines as needed).
  • Psychological Evaluation & Interpretation Standardized testing and interpretation to inform treatment selection and planning; may include psychosocial assessments and goal-directed psychotherapy for children and adolescents.

How to Participate

For details, forms and updates, visit the Current Service Needs page.

Providers Needed for Court-Ordered Evaluations

Partners is seeking providers who are able and willing to complete court-ordered evaluations in Surry County. These evaluations include Multidisciplinary Evaluations (MDEs) and other forensic screening services for individuals across all disability groups, including those involved in incompetency and adult guardianship cases.

An MDE is a comprehensive assessment ordered by the clerk of court to help determine an individual’s competency during guardianship proceedings. It includes evaluations from medical, psychological and social work professionals, and may also involve experts in education, psychiatry and vocational rehabilitation. These evaluations assess a person’s cognitive and functional abilities and must be completed by qualified providers.

Providers are needed immediately in Surry County and throughout Partners’ 15-county service area.

To learn more or to become a Court-Ordered Evaluations provider, contact Michelle Russell, Court-Ordered Evaluations Coordinator at 980-745-3497 or email CourtOrderedEvaulations@PartnersBHM.org.

HCBS Assessment Requirements Update

Partners reminds providers of key requirements for Home- and Community-Based Service (HCBS) assessments. These assessments ensure individuals receive the right supports in the most integrated setting and help maintain compliance with federal HCBS regulations.

Providers must submit the HCBS Provider Self-Assessment for any setting delivering Residential Supports, including:

  • 5600(b) and 5600(c) group homes
  • Licensed 5600(f) AFL (Alternative Family Living) homes
  • Unlicensed Alternative Family Living (UAFL) homes

Providers must not begin services or billing in a UFAL until Partners reviews each self-assessment to confirm full compliance with HCBS settings requirements, and Quality Management (QM) Monitoring verifies compliance for a UAFL and completes a health and safety review of the site.

Accurate HCBS assessments support person-centered planning and ensure services align with federal and state standards. Partners encourages providers to review their processes and confirm that staff responsible for assessments understand current requirements.

Learn more and complete the HCBS Provider Self-Assessment.

For assistance, contact QM Monitoring at QMMS@PartnersBHM.org.

Understanding Program Integrity Paybacks

When Partners identifies an overpayment through Program Integrity reviews, providers must return the funds in accordance with state and federal requirements. Overpayments occur when a provider receives payment that they were not entitled to, such as billing errors, non-compliant documentation or delivering services outside policy or contract standards.

Common reasons for paybacks include:

  • Missing or incomplete documentation
  • Services billed that were not delivered
  • Claims that do not match the service definition
  • Non-compliance with authorization or eligibility requirements
  • Billing outside the required time frame

If Partners identifies an overpayment, the provider receives written notice explaining the findings, the amount owed and options for repayment. Providers may:

  • Repay the full amount
  • Request an approved repayment plan
  • Submit additional information if they believe the findings are incorrect

Program Integrity paybacks help protect Medicaid funding, support accurate billing practices and ensure that services align with state and federal regulations.

Transition of Care Updates

Partners encourages providers to take an active role in helping members navigate transitions of care, including changes in NC Medicaid health plans. Clear communication during these transitions protects continuity of services and reduces disruption for members.

Changing NC Medicaid Health Plans

Members must contact the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711) to change plans. Health plans, including Partners, cannot move members.

Members, providers or care managers may:

  • Request a plan change at any time
  • Submit a Request to Move (RTM) to Tailored Plan form, available on the NCDHHS website
  • Call the Enrollment Broker if NC Medicaid reassigns them and they want to return to a previous plan
  • Contact their local DSS if changing administrative counties

For detailed guidance, review the Transition of Care policy.

Children and Families Specialty Plan (CFSP)

The Children and Families Specialty Plan (CFSP) is a managed care plan for children and families who are:

  • In foster care
  • Formerly in foster care
  • Receiving adoption assistance

Effective Dec. 1, 2025, some members will be enrolled in the CFSP, administered by Blue Cross and Blue Shield of North Carolina under the name Healthy Blue Care Together. The CFSP provides:

  • Physical and behavioral health services
  • Pharmacy services
  • Long-term services and supports
  • Care management

Members may:

  • Stay in the CFSP
  • Move to Partners’ Tailored Plan
  • Choose a Standard Plan

To opt out of the CFSP and change plans, members, providers and care managers can contact the Enrollment Broker at: 1-833-870-5500 (TTY: 711).

How Providers and Partners Can Help

  • Talk with members about health plan options
  • Help members understand which plan best fits their needs
  • Direct members to the Enrollment Broker for plan changes
  • Coordinate transitions so services and medications continue without interruption

Partners Health Management can help members and providers understand available options. Contact Partners Member Services at 1-888-235-4673 or MemberQuestions@PartnersBHM.org.

Partners NC-TOPPS Updates

Partners has updated the NC-TOPPS section of the Provider Knowledge Base to make training and performance information easier to assess.

Updated Training Access

  • The NC-TOPPS training webinar has moved
  • Under the Training and Resources header, providers will now find a direct link to the updated video content
  • Viewers must register through the link before watching the training

Kudos Corner – Q4 FY 24-25

Partners updated the NC-TOPPS Kudos Corner to highlight providers who achieved a high percentage of required initial interviews during Q4 of FY 24-25. We appreciate the strong accuracy, timeliness and follow-through shown across agencies.

We have also added a new recognition category that highlights ACTT provider performance.

Visit Partners’ NC-TOPPS webpage for more information.

Clinical Coverage Policies

Utilization Management uses clinical coverage policies to administer benefits and determine medical necessity. Service definitions and clinical policies guide when and how services are covered for physical health, behavioral health, substance use disorders, and intellectual/developmental disabilities. Read more on the Service Definitions page on the Partners Provider Knowledge Base. For questions, email UMQuestions@PartnersBHM.org.

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

  • Once requested, 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.

Avoid Delays: Follow the Correct Claims Reconsideration Process
We’ve noticed an increase in claims reconsideration requests being sent to the Provider Dispute Email, which can delay processing. To ensure your request is managed quickly and correctly, follow the Claims Reconsideration Process outlined on our website.

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

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

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 actions. This training is approved by the North Carolina Substance Abuse Professional Practice Board (NCSAPPB) 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 North Carolina 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 six 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 North Carolina 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 I/DD 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 the 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.

Risk & Resilience: Buffering Toxic Stress
Dec. 1, 2025 | 2-4 p.m. (Register)
This 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. The class teaches how to help young children calm their limbic systems. For older children, we will learn about healing the cortical brain to develop active coping skills such as impulse control and problem solving.

Maternal Mental Health
Dec. 2, 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.

Question, Persuade, Refer (QPR) Suicide Prevention
Dec. 3, 2025 | 10 a.m.–noon (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.”

Emotional Intelligence (EI) Essentials
Dec. 3, 2025 | 2 p.m. (Register)
This training introduces the core components of emotional intelligence and teaches practical skills to manage emotions, improve communication and build strong relationships in daily life and work.

Diabetes 101
Dec. 4, 2025 | 10 a.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.

Human Trafficking
Dec. 5, 2025 | 10 a.m. (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.

Active Listening & De-escalation
Dec. 8, 2025 | 2 p.m. (Register)
This training focuses on active listening skills, empathy and habits to keep yourself and other people safe. There will be discussion about how our own experiences impact our ability to assist others in high-stress situations.

Hypertension
Dec. 10, 2025 | 10 a.m. (Register)
This training provides overview of high blood pressure, including prevention, early detection, risk factors and complications. Participants learn self-management strategies and how to use community and online resources to support heart health.

Community Resiliency Model (CRM)®
Dec. 10, 2025 | 2 p.m. (Register)
The Community Resiliency Model (CRM) ® teaches participants about the impact of trauma and chronic stress on the nervous system, behaviors and long-term health. Participants will learn how to reset the nervous system with easy-to-learn, concrete coping skills resulting in resilient communities.

Nutritional Impacts on Mental Health
Dec. 12, 2025 | 10 a.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.

Stress Management
Dec. 12, 2025 | 12 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.

Mental Health 101
Dec. 15, 2025 | 2 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.

Understanding Grief
Dec. 16, 2025 | 2 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.

Non-Suicidal Self-Injury
Dec. 17, 2025 | 12 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.

Substance Use Disorder: Overview, Recovery and Resources
Dec. 18, 2025 | 2 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.

Trauma, Resilience and Trauma Informed Care
Dec. 19, 2025 | 10 a.m. (Register)
Trauma impacts learning, behavior and health outcomes. Learn about trauma, how to address its effects and develop resiliency. We will look at how our behavior impacts others with a trauma history and learn the elements of trauma informed care.

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