Issued: December 8, 2025
In a provider alert posted Oct. 31, 2025, Partners Health Management announced it would re-adjudicate claims with a date of service Oct. 15-Oct. 31, 2025, the week of Nov. 15, 2025. This re-adjudication did not occur and has been rescheduled for the week of Jan. 12, 2026, and includes any adjudicated claims with a claims process date prior to Nov. 1, 2025.
You can read the Oct. 31 alert here.
What is happening?
Partners will re-adjudicate adjudicated claims with a claims process date prior to Nov. 1, 2025, the week of Jan. 12, 2026.
Why is this happening?
- This is happening because claims were not re-adjudicated as planned the week of Nov. 15, 2025.
- In response to a shortfall in appropriations from the General Assembly, the North Carolina Department of Health and Human Services developed a plan that required provider rate reductions to fully support the state’s Medicaid rebase. The rate cuts took effect Oct. 1, 2025, but Partners and the state’s other LME/MCOs delayed implementation until Nov. 1, 2025, to help minimize provider disruptions.
- Partners released a schedule to recoup the claims paid at the former (higher) rate as soon as possible after Nov. 1. Claims were re-adjudicated the week of Nov. 1 for adjudicated claims with a service date of Oct. 1-Oct. 14, 2025. Claims with dates of service Oct. 15-Oct. 31, 2025, were planned to be re-adjudicated the week of Nov. 15, 2025.
What do providers need to do?
No action is needed by Partners’ providers. However, providers should prepare for adjustments in claims and reimbursement and monitor communications from Partners closely for further updates.
Who can providers contact if they have questions?
Questions related to claims reprocessing can be sent to ClaimsDepartment@PartnersBHM.org.