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Provider Communication Bulletin #171

In This Bulletin:

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Partners Office Closure

Partners Health Management offices will be closed Wednesday, Dec. 24 through Friday, Dec. 26, 2025 and Thursday, Jan. 1, 2026, in observance of the Christmas and New Year holidays.

Provider Information Sessions: NC CWTIA

Interested in becoming part of North Carolina’s trauma-informed transformation of child welfare? Join a North Carolina Child Welfare Trauma-Informed Assessment (CWTIA) Provider Information Session to learn how your agency can participate in this important work.

These virtual sessions are open to agencies and independent clinicians who want to understand the opportunity and next steps to becoming a CWTIA provider.

Who should attend:

  • Behavioral health providers interested in providing the NC CWTIA
  • Clinical directors and program managers
  • Agencies committed to a trauma-informed child welfare system

Register for one of the three dates below:

Update: TBI Allocation Available

Partners Health Management administers an annual allocation for Traumatic Brain Injury (TBI) State Funding. Limited funds remain available for the current fiscal year.

Providers and organizations seeking funding TBI must review the Partners TBI Funding Guidelines and submit a completed Partners TBI Funding Request Application to UMSpecializedFunding@PartnersBHM.org by Dec. 31, 2025. Requests will be reviewed in the order they are received while funds remain available.

Please note: Annual resubmission is required. Providers currently receiving TBI funding must resubmit all required documentation by May 1 to continue receiving support. Incomplete submissions will not be considered.

Required Documentation

*Requests are not considered complete without required documentation.
Direct Services Equipment or Modification
Partners’ TBI Funding Request Application Partners’ TBI Funding Request Application
Medical documentation to confirm TBI diagnosis (only for new requests) Medical documentation to confirm TBI diagnosis (only for new requests)
Cost Finding Form Letter of Medical Necessity
Corresponding service order (QP) Two quotes
Treatment Plan NC-SNAP or SIS
NC-SNAP or SIS

TBI funding is not an entitlement and does not include appeal rights. However, the Partners grievance procedure applies.

For questions, contact:

New Guidance on Metformin

Partners is sharing new, evidence-based clinical guidance on the use of metformin to help prevent antipsychotic-induced weight gain, a common and clinically significant side effect of antipsychotic treatment.

A 2025 international guideline published in Schizophrenia Bulletin is the first consensus-based guideline to recommend metformin for prevention, not just treatment, of antipsychotic-related weight gain. The guidance reflects growing evidence that early intervention may reduce cardiometabolic risk, support treatment adherence and improve long-term health outcomes for individuals receiving antipsychotic medications.

Key points for providers:

  • Metformin may be considered for:
    • All patients prescribed olanzapine or clozapine.
    • For patients prescribed paliperidone, quetiapine or risperidone who have cardiometabolic risk factors, a BMI greater than 25 or who are ages 10-25.
    • For any patient with more than 3% increase in body weight during the first year of antipsychotic treatment.
  • Gradual dose titration and ongoing renal metabolic monitoring are recommended.
  • Metformin should be avoided or discontinued in certain situations, including severe renal impairment, low BMI or discontinuation of antipsychotic medication.

Current Service Needs

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

Priority Service Gaps

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.

Clinically Managed Residential Withdrawal Services (Adult): Clinically managed residential withdrawal services, also referred to as a social setting detoxification, are organized, facility-based services that provide 24-hour supervision, observation and support for adults who are intoxicated or experiencing withdrawal. Services are delivered by appropriately trained staff and focus on monitoring, stabilization and referral to ongoing treatment as needed. This service is needed for NC Medicaid Direct and Tailored Plan and is scheduled to go live Jan. 1, 2026.

Ongoing Needs

  • Psychological Evaluation and 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.

HCBS Compliance Scenarios

Clarification and Compliance Scenarios

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.

The following scenarios provide additional guidance to support compliance:

Unlicensed Alternative Family Living (UAFL) Home Changes Providers

When a UAFL home transitions to a new site with a new provider:

  • The new provider must immediately notify Partners and submit a new HCBS Provider Self-Assessment for the site to confirm compliance, including the one-person/one adult requirement.
  • The self-assessment must be reviewed and accepted, and Quality Management (QM) Monitoring must complete an approved site review before services begin under the new provider.
  • Required documentation must be updated with NC Medicaid/NCDHHS to avoid service disruptions.
  • Any provider change triggers a compliance review to ensure the setting continues to meet HCBS requirements, with Partners serving as the primary coordinator during the transition.

Members Transfer Between Local Management Entity/Managed Care Organizations (LME/MCOs) While in an Alternative Family Living (AFL) Home

When a member in an AFL home changes LME/MCOs:

  • The provider must immediately notify both the current and receiving LME/MCO of the member’s LME/MCO change.
  • The current and new LME/MCOs coordinate the transfer of the member’s information and HCBS assessment records.
  • If Quality Management Monitoring cannot obtain the existing HCBS assessment through coordination, the provider must submit an updated HCBS Provider Self-Assessment for the UAFL site to the new LME/MCO.
  • The receiving LME/MCO assumes responsibility for HCBS oversight and confirms compliance before services continue, which may include an onsite review within 30 days.

Learn more and complete the HCBS Provider Self-Assessment.

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

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 (SUD), and intellectual/developmental disabilities (I/DD). 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 training 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) Three-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 the impact of trauma 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 disability (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, 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. Provider 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 four 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 the 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.

Question, Persuade, Refer (QPR) Suicide Prevention
Jan. 6, 2026 | 10 a.m. (Register)
Jan 28, 2026 | 2 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, save a life.”

Community Resiliency Model (CRM)®
Jan. 6, 2026 | 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.

Hypertension
Jan. 7, 2026 | 2 p.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.

Mental Health 101
Jan. 12, 2026 | 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.

Emotional Intelligence (EI) Essentials
Jan. 13, 2026 | 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.

Trauma Part 1: Introduction to Trauma and Resilience
Jan. 14, 2026 | 12 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. This is a one-hour training.

Active Listening & De-escalation
Jan. 14, 2026 | 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.

Maternal Mental Health
Jan. 20, 2026 | 2 p.m. (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.

Human Trafficking
Jan. 22, 2026 | 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.

Diabetes 101
Jan. 22, 2026 | 2 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.

Non-Suicidal Self-Injury
Jan. 27, 2026 | 10 a.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
Jan. 27, 2026 | 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.

Understanding Grief
Jan. 29, 2026 | 10 a.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 Impacts on Mental Health
Jan. 29, 2026 | 2 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.

Trauma Part 2: Trauma-Informed Care
Jan. 30, 2026 | 12 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. This is a one-hour training. *Trauma-Informed Care Probation/Parole available upon request.

Child & Family Team (CFT) Training Part One
Feb. 3-4, 2026 | 9 a.m. – 4 p.m. (Register)
This System of Care training is a two-day, 11-hour experiential training. Child and Family Team training provides an overview from the family’s perspective. The training reinforces the idea of “one family, one plan” by addressing CFT through the lens of multiple systems. Attendees must be present and on camera during the full two-day training to be eligible for a certificate of completion. *Offered quarterly, either virtually or in-person.

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