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Provider Communication Bulletin #174

In This Bulletin:

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Partners Holiday Closure

Partners Health Management will be closed on Friday, April 3, 2026, in observance of Good Friday.

If you or someone you serve is experiencing a behavioral health crisis during this time, please call the Behavioral Health Crisis Line at 1-833-353-2093, available 24 hours a day, seven days a week.

Regular business hours will resume on Monday, April 6, 2026.

HCBS Mandatory Training

Partners is hosting a standardized mandatory training for Home and Community Based Services (HCBS), including Innovations Waiver (1915c) providers of Residential, Day and Supported Employment (corporate) sites.

The training will cover:

  • HCBS database updates
  • Annual compliance attestation requirements
  • New security measures related to HCBS database access and use

Providers must attend of the two training sessions below. Registration is required to ensure documented provider attendance rosters.

  • Friday, April 17, 2026 | 2-3:30 p.m. | Register
  • Friday, April 24, 2026 | 1-2:30 p.m. | Register

Physical Health Provider Updates

Partners’ Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan collaborates with Carolina Complete Health (CCH) to support physical health providers participating in the Tailored Plan. The Partners/CCH Special Bulletin offers valuable guidance on enrollment, claims processing, authorizations and compliance requirements.

Claims Processing Updates

Upfront Rejections

Beginning April 1, 2026, Partners and CCH will transition from issuing claim denials to issuing upfront rejections for select adjudication codes.

If a claim is rejected, providers must correct the identified issue and resubmit the claim.

Providers should refer to the CCH special bulletin for a full list of applicable codes and errors that will result in an upfront rejection.

Tips to Prevent Rejections

  • Confirm billing matches credentialing details in NCTracks, including NPI and taxonomy
  • Ensure NPI and taxonomy are entered in the correct claim fields
  • Follow guidance in the CCH Provider Billing Manual (pages 48–74)
    • For instance, if services are performed at a location different from the billing address in Field 33, providers must complete Boxes 32, 32a, and 32b on the claims.

Claim Dispute Timely Filing

Effective April 1, 2026:

  • Contracted providers: 90 calendar days from the Explanation of Payment (EOP) or Electronic Remittance Advice (ERA) date to submit a claim dispute
  • Non‑contracted providers: 60 calendar days from the EOP/ERA date to submit a claim dispute

This replaces the previous 365‑day timeframe for disputes on claims processed by Partners via Carolina Complete Health.

What Remains the Same:

  • Providers have 365 calendar days from the date of service or date of discharge to submit an initial claim
  • Providers have 365 calendar days from the date of service or date of discharge to submit a claim correction

Hospital Inpatient Claims

Effective April 15, 2026, hospital inpatient claims for physical health services exceeding $250,000 will transition from post‑payment review to pre‑payment review.

Claims meeting this threshold must include an itemized bill at submission.

This review will continue to be administered by the current vendor, 6 Degrees Health, and is related to the merger of WellCare of North Carolina Health Plan and Carolina Complete Health Plan.

UM Vendor Changes

Beginning April 1, 2026, Partners and CCH will update utilization management vendors for the following services. Providers should review vendor-specific resources for additional details.

Service Current Vendor Future Vendor Vendor Information
Radiation Oncology None Evolent:

Effective no earlier than 5/1/26

 RADMD | Radiation Oncology
Musculoskeletal Surgery None Evolent:

Effective 4/1/26

 RADMD | Musculoskeletal Surgery (MSK)
Interventional Pain Management None Evolent:

Effective 4/1/26

 RADMD | Interventional Pain Management (IPM)
Cardiovascular Procedures None TurningPoint:

Effective 5/1/26

 My TurningPoint Healthcare
Genetic Testing None EviCore:

Effective no earlier than 5/1/26

 Homepage | EviCore by Evernorth

Clinical Coverage Policy Updates

Breast Surgeries

Reduction mammoplasty is now recognized as a standalone medically necessary procedure, not only as part of reconstructive surgery.

Updated criteria include:

  • Age requirements
  • Tissue removal thresholds
  • Symptoms and conservative treatment
  • Breast cancer screening requirements

Expanded documentation requirements now apply for all breast surgeries, including:

  • Symptoms
  • Pre-operative photographs
  • Treatment history

Providers should review the full Breast Surgeries NC.CP.MP.501 policy for details.

Provider Training and Office Hours

Partners and Carolina Complete Health host office hours for Partners Tailored Plan physical health providers on the first Tuesday of each month at noon.

Providers are encouraged to register and submit questions in advance.

Archived sessions are available on CCH’s Partners Tailored Plan Provider Resources page.

Questions

For more information related to Physical Health Utilization Management, contact PHUMQuestions@PartnersBHM.org.

TBI Funding Deadline

Providers and organizations seeking Traumatic Brain Injury (TBI) allocation must review the Partners TBI Funding Guidelines and submit a completed Partners TBI Funding Request Application to UMSpecializedFunding@PartnersBHM.org by May 1, 2026.

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 Sara Wilson at SWilson@PartnersBHM.org.

FEP Survey

Partners is conducting a survey to assess provider capacity for delivering First Episode Psychosis (FEP) Treatment services.

The purpose of this assessment is to:

  • Evaluate current provider capability to support FEP treatment programs
  • Identify supports needed to sustain or enhance existing programs
  • Assess interest in expanding FEP treatment capacity across the network

Provider feedback helps Partners better understand system strengths and determine how to support early-intervention mental health services.

Complete the First Episode Psychosis Survey.

NC-TOPPS Survey

Partners would like to thank all providers who participated in the NC-TOPPS Focus Groups held between October and December 2025.

A brief follow-up survey has been sent via email to participants who provided an email at registration. If you did not receive the survey, you may access the NC-TOPPS Focus Group survey here.

GCQI Recruitment

Partners is seeking provider participation in the Global Continuous Quality Improvement (GCQI) committee. The GCQI committee supports ongoing quality improvement efforts across the network and includes provider representation.

Partners is currently seeking:

  • An Intellectual/Developmental Disability (I/DD) co-chair (needed before the next quarterly meeting on June 5, 2026, at 9:30 a.m.)
  • A Mental Health and Substance Use co-chair (term beginning in September 2026)

Co-chairs serve a one-year term that can be renewed for an additional year and share the following responsibilities:

  • Setting agenda priorities
  • Representing provider perspective
  • Reporting to various committees
  • Facilitating GCQI quarterly meetings

Providers interested in participating or serving in a co-chair role should email Tamikka Woods at TWoods@PartnersBHM.org.

Intensive Care Management

Partners offers an Intensive Care Management (ICM) Program to support members with complex behavioral health and physical health needs. ICM is part of Tailored Care Management and is a Complex Case Management program.

Eligibility

Members who have:

  • More than one long-term (chronic) physical health condition
  • And a behavioral health condition or intellectual/developmental disability

How ICM Supports Members

Members have a care team led by a nurse to:

  • Help manage physical health, behavioral health and/or mood
  • Help prevent crises
  • Follow up after emergency department or hospital visits
  • Support members in staying well at home.

Referrals

Members can be referred for eligibility screening in the following ways:

For more information, email: PopulationHealthPrograms@PartnersBHM.org

I/DD Patient Support

Partners has developed an I/DD Patient Support page in the Provider Knowledge Base to help providers support individuals with intellectual/developmental disabilities.

This page includes tools and resources to help providers:

  • Share information with members and caregivers
  • Connect individuals to home and community-based services
  • Better support overall health and wellbeing

Providers are encouraged to explore and use these resources when working with individuals with I/DD.

Visit Partners’ I/DD Patient Support page.

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 the 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 seen an increase in claims reconsideration requests 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, 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 must have Microsoft Teams screen-sharing capabilities for more specific and in-depth training.

State Benefit Health Plans

Providers now have the option to request appropriate State Benefit Health Plans (AMI, ASTER, etc.) with a future date. Providers may request this 60 days prior to the current end date.

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.

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.

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.

Mental Health 101
April 1, 2026 |10 a.m. – noon (Register)
Learn about mental wellness, potential signs and symptoms of mental health challenges, and some of the common behavioral health disorders. The training also includes information about treatment and what to do in a crisis.

Domestic Violence: How to Help
April 1, 2026 | 1 – 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. This training is for three hours.

Trauma Part One: Introduction to Trauma and Resilience
April 2, 2026 |10 a.m. – noon (Register)
Most of us have experienced trauma at some time. This can have a lasting effect on our learning, behavior and health. Learn about trauma, how to address its effects and develop resilience.

Active Listening/De-escalation
April 7, 2026 | 2 – 4 p.m. (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.

Diabetes 101
April 9, 2026 | 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.

Non-Suicidal Self-Injury Lunch and Learn
April 9, 2026 |noon – 1 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.

Hypertension
April 15, 2026 |10 a.m. – noon (Register)
This training provides an 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.

Maternal Mental Health
April 16, 2026 |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.

Emotional Intelligence (EQ) Essentials
April 16, 2026 |2 – 4 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.

Understanding Grief
April 20, 2026| 2 – 4 p.m. (Register)
Are you experiencing grief, or do you know someone who is grieving? In this training, you will learn about the various causes, phases and other information related to the grieving process.

Question, Persuade, Refer (QPR) Suicide Prevention
April 21, 2026 |10 a.m. – noon (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.” *Disponible en Español 

Nutritional Impact on Mental Health
April 21, 2026 | 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
April 22, 2026 | 10 – 11 a.m. (Register)
Join us for our monthly Community Café: Bright Beginnings-Resources for Preschoolers. The café will highlight several resources to give our young children the best opportunity to grow and thrive.

Preguntar, Persuadir y Referir                  
22 de abril de 2026 | 6 – 8 p.m. (Registrate)
Prevención del Suicidio Preguntar, Persuadir, Referir (PPR): Este entrenamiento basado en evidencia enseña las habilidades para reconocer las señales de advertencia del suicidio e intervenir en una crisis suicida. “Haz una pregunta, salva una vida.”

Substance Use: Overview, Recovery & Resources
April 23, 2026 |10 a.m. – noon (Register)
This training explains substance use disorder, its health impacts and the effects of common substances. Participants learn how to recognize signs, support recovery and connect people with helpful local and online resources.

Community Resiliency Model (CRM)®
April 23, 2026 |2 – 4 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 learn how to reset the nervous system with easy-to-learn, concrete coping skills, resulting in resilient communities.

Stress Management
April 24, 2026| 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.

Trauma Part Two: Trauma-Informed Care
April 30, 2026 | 10 a.m. – noon (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. *Trauma Informed Care Probation/Parole & Trauma Informed Care for Schools available upon request.

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