Physical Health Updates
The 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.
Prior Authorization Reminders
Durable Medical Equipment and Orthotic and Prosthetic Procedure Codes
A new prior authorization is required for manually priced Durable Medical Equipment (DME) and Orthotic and Prosthetic (O&P) procedure codes when a member transitions from NC Medicaid Managed Care to NC Medicaid Direct.
Most prior authorizations (PAs) approved through an NC Medicaid Managed Care health plan transfer to NC Medicaid Direct. However, the North Carolina Department of Health and Human Services (NCDHHS) has identified system and process differences that affect manually priced DME and O&P procedure codes. These PAs may be transferred to NCTracks without the information needed to process the associated claims.
As a result:
- Health plans should not return PAs with manually priced DME and O&P procedure codes to NCTracks.
- PAs with manually priced procedure codes submitted to NC Medicaid Direct by health plans will be rejected.
What do providers need to do?
DME and O&P providers must submit a new prior authorization (PA) request through NCTracks for manually priced procedure codes when a member transitions from NC Medicaid Managed Care back to NC Medicaid Direct.
A new PA is required even when the member already has an approved authorization through an NC Medicaid Managed Care health plan.
This requirement includes unlisted HCPCS codes B9998, E0986, E1012, E1399 and K0108.
Retroactive PA Requests
For members who returned to NC Medicaid Direct on or after April 1, 2023, providers must submit retroactive PA requests within 90 days of the health plan’s recoupment notice date. The retroactive PA effective date will be the later of:
- The member’s NC Medicaid Direct coverage start date.
- The date that the service was authorized.
Providers should verify authorizations in NCTracks and submit claims based on the authorization information available in the system.
When services fall outside the 90-day submission period, or when providers experience problems submitting a retroactive PA or claim, they should contact the NC Medicaid Managed Care Provider Ombudsman at 866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov for assistance with claim reprocessing.
Requests for assistance should include:
- Email subject: Retro Disenrollment Claims Issue
- Provider name and NPI
- Previous health plan
- Medicaid ID (MID)
- Services provided, including procedure codes
- Dates of service or dispensing
Documentation Requirements
Retroactive PA requests must include documentation of the health plan’s PA history, including a copy of the health plan PA, if available.
Verifying Eligibility
Before providing services or submitting a PA request, providers should always verify the member’s:
- Current NC Medicaid eligibility
- Managed Care enrollment status
- Existing authorizations in NCTracks
CMS Prior Authorization Timeline Changed
Effective July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) implemented new prior authorization (PA) response time requirements for all providers.
- Standard PA requests will be processed within seven calendar days, reduced from the current 14-day timeframe, with an extension of up to 14 calendar days permitted in certain circumstances.
- Expedited/urgent PA requests will continue to be completed within 72 hours.
Providers can expect faster turnaround times for standard PA requests. Because timeframes will be shorter, providers are encouraged to submit all required clinical documentation with the initial authorization request. Incomplete clinical information may result in denial due to insufficient supporting records.
For more information about submitting authorizations, visit Partners’ Prior Authorization information page.
Provider Training and Office Hours
Partners and CCH 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.
Current Service Needs
Partners has identified the following service gaps. Providers are needed across our 15-county service area. For details, forms and updates, visit the Current Service Needs page.
Priority Service Gaps
Clinically Managed Residential Withdrawal Services (Social Setting Detoxification): 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 members 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.
Ongoing Needs
- Multidisciplinary Evaluation (MDE): Court-ordered, comprehensive assessments for guardianship proceedings (medical, psychological, social work; other disciplines as needed).
- 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
- Review requirements and next steps on the Current Service Needs page.
- Already in the Partners network? Complete the Provider Change Form.
- Not yet in the network? Submit the Request for Consideration Form.
- NCTracks required: Your agency, NPI, taxonomy, sites and clinicians must be enrolled in NCTracks to contract with Partners and make contract changes.
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.
Level III Incident Notifications
- All Level III incidents must be reported to Partners immediately. For Partners members, notifications should be emailed to IRIS@PartnersBHM.org.
Include Accurate Information
Before submitting an IRIS report:
- Confirm all demographic information is complete and accurate, including:
- Correct spelling of the member’s name
- Date of birth
- Host LME/MCO county (county where services are provided)
- Home county (county where the member’s Medicaid originates)
- Member’s LME/MCO number
- Client Record Number (CRN)
- CNDS ID
- Medicaid ID
Partners may need to contact the provider when additional details or documentation are needed.
- Include appropriate staff member or supervisor:
- Name
- Phone number
- Email address
- Submit all requested supporting documentation within five business daysof the request.
- Review your submitted IRIS reports daily for comments, requests for additional information or documentation needs from Partners.
IRIS Training
Partners offers an on-demand Incident Response Improvement System Demonstration training for providers.
For additional technical assistance related to IRIS, please email IRIS@PartnersBHM.org.
Read the full requirements and access the trainings here.
CURESZ Clinical Resource
The CURESZ Foundation provides advocacy, education, information and support to improve understanding of schizophrenia as a treatable neuropsychiatric illness. The foundation shares information about underused and emerging medications and treatments for schizophrenia, including medical updates about alternative treatments for individuals, families, clinicians and treatment teams.
The foundation is also developing CLOSZE (Clozapine in Schizophrenia Experts), a national network of clozapine experts and prescribers. Providers can use the CLOSZE directory to locate an expert or clozapine prescriber in their area.
- Learn more about the CUREZ Foundation
- Learn more about the CLOSZE expert panel
- Find a CLOSZE expert or prescriber
Claims Information
To help avoid payment delays, duplicate submissions, recoupments and misrouted requests, providers are reminded to review the following claims guidance.
Avoid Claim Delays
Partners has observed an increase in claims status inquiries from clearinghouses. Providers using a clearinghouse for claim reconciliation must ensure that their staff has access to remittance advice. Providers are also reminded to follow these claim submission requirements:
- Submit each benefit plan on separate claims.
- Include all diagnosis codes on claims. Diagnosis codes help Partners measure member health, identify areas of risk and evaluate the quality of care.
Prevent Duplicate Claims
Partners has recently observed an increase in duplicate claims. To help prevent duplicate submissions, providers should:
- Check claim status before resubmitting.
- Allow enough processing time to avoid premature resubmissions.
- Submit corrections correctly using the proper frequency code.
- Review denial reasons and fix issues before resubmitting.
- Use claim tracking tools to monitor status and next steps.
Submit Physical Health Paper Claims
Physical Health paper claims should be mailed to:
Partners Health Management
Attn: Claims
PO Box 8002
Farmington, MO 63640-8002
Respond to EOB Requests
Partners requests copies of Explanation of Benefits (EOB) documents for members/claims submitted with Coordination of Benefits. Requests will be sent by email from Partners Claims staff. When an EOB is requested:
- Submit the information by secure email before the date specified in the request.
- If a response is not received, the original claim payment will be recouped.
Follow the Claims Reconsideration Process
Partners has seen an increase in claims reconsideration requests sent to the Provider Dispute email inbox, which may delay processing. To ensure requests are handled quickly and correctly, providers should follow the Claims Reconsideration Process outlined on the Partners website. Providers should:
- 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.
- Access Availity® in ProviderCONNECT under the “Physical Health Claims” Quick Links box for Physical Health claims.
For all claims-related questions, providers should contact the Claims Department at ClaimsDepartment@PartnersBHM.org. To avoid delays in receiving a response, do not contact individual claims staff directly.
Check 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. Providers must have Microsoft Teams screen-sharing capabilities for more specific and in-depth training.
Request 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.
Recent Provider Alerts
- July 11, 2026: Updated In Lieu of Service (ILOS) – Child ACT Service Definition
- July 8, 2026: Changes to RB-BHT and Peer Support Services
- July 1, 2026: Vaya Partners Contracting and Merger Information Sessions
- June 18, 2026: Partners Website Update
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.
Diabetes 101
Aug. 4, 2026 | 10 a.m. – noon (Register)
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.
Substance Use: Overview, Recovery & Resources
Aug. 5, 2026 | 2 – 4 p.m. (Register)
This training explains substance use disorder, its health impacts and effects of common substances. Participants learn how to recognize signs, support recovery and connect people with helpful local and online resources.
Introduction to Child and Family Team (CFT) Training (Part 1)
Aug. 5, 2026, and Aug. 6, 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 seeks to reinforce the idea of “one family, one plan” by addressing CFT through the lens of multiple systems. Offered quarterly either virtually or in-person
Understanding Grief
Aug. 6, 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.
Darkness to Light: Child Safety Foundations
Aug. 7, 2026 | noon – 1p.m. (Register)
This evidence-informed training discusses preventing, recognizing and reacting responsibly to child sexual abuse. Learn ways to confidently talk with children and listen to their concerns about sexual abuse and personal safety. This training is one hour.
Wellness and Wellbeing
Aug. 11, 2026 | 2 – 4 p.m. (Register)
Let’s get together and talk about developing habits that support a healthier, more balanced life. This interactive training touches on mindfulness, resilience, stress‑reduction techniques, and self‑care strategies. We will discuss practical tools to improve daily functioning and long‑term wellbeing.
Question, Persuade, Refer (QPR) Suicide Prevention
Aug. 12, 2026| 2 – 4 p.m. (Register)
This evidence-based training teaches the skills to recognize warning signs of suicide and intervene in a suicide crisis. “Ask a question, save a life. *Disponible en Español.
De-influencing Social Media: Connected, Not Consumed
Aug. 13, 2026 | 10 a.m. – noon (Register)
This training explores how social media influences mental health, relationships, communication, and community well-being. Participants will examine the positive and negative impacts of social media use, including misinformation, comparison culture, polarization, and emotional regulation, along with practical strategies for healthier engagement.
Hypertension
Aug. 14, 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.
Women’s Health
Aug. 18, 2026 | 2 – 4 p.m. (Register)
During this training we will discuss women’s health topics across the lifespan from adolescent to senior years. The focus of this training is to highlight the cumulative experience of reproductive, physical and mental health for women.
Trauma: Introduction to Trauma and Resilience and Trauma-Informed Care
Aug. 19, 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. We will look at how our behavior affects others who have a history of trauma and learn about the elements of trauma-informed care.
Active Listening/De-escalation
Aug. 20, 2026 | 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 discussion about how our own experiences impact our ability to assist others in high-stress situations.
Internet Safety
Aug. 20, 2026| 2 – 4 p.m. (Register)
Children are spending more time online than ever before – learning, gaming, and connecting with friends. This training equips parents and caregivers with practical tools and knowledge to help children learn to navigate the internet safely and responsibly. Participants will learn about online risks, including inappropriate content, sextortion, and cyberbullying, as well as strategies for setting healthy digital boundaries.
Nutritional Impact on Mental Health
Aug. 21, 2026 | 10 a.m. – noon (Register)
Join us for an insightful training on the intricate relationship between eating behaviors and mental health. This interactive training will explore how our dietary choices and habits can profoundly influence our mental well-being, emphasizing the crucial connection between nutrition and mental health.
Emotional Intelligence (EQ) Essentials
Aug. 25, 2026 | 10 a.m. – noon (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.
Maternal Mental Health
Aug. 25, 2026 | 2 p.m. – 4 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.
Community Café
Aug. 26, 2026 | 10 – 11 a.m. (Register)
As our young people get back into school routines, join us to discuss safe internet habits, healthy boundaries with social media, and more!
Caring for the Caregiver
Aug. 27, 2026 | 10 a.m. – noon (Register)
Caring for a loved one can be meaningful, but it can also be physically and emotionally exhausting. This training explores the signs and symptoms of burnout, common stressors and the impact of prolonged stress on overall well-being. Participants will gain practical tools for setting healthy boundaries, managing stress and sustaining themselves while continuing to care for others.
Domestic Violence: How to Help
Aug. 27, 2026| 1 – 4 p.m. (Register)
How do we help someone in a violent relationship? Join us for practical training that equips professionals and community members to recognize domestic violence, respond safely and ethically, and connect survivors to resources. Learn how to help someone in a violent situation. This is a three-hour training.
Mental Health 101
Aug. 31, 2026 | 2 – 4 p.m. (Register)
Learn about mental wellness, potential signs and symptoms of mental health challenges and some of the common behavioral health disorders. The training also includes information about treatment and what to do in a crisis.