Partners Tailored Plan Provider Resources

Claim Reconsideration

Follow the Correct Claims Reconsideration Process

To ensure timely review and response, providers must follow the Claims Reconsideration Process  outlined on the Partners website.

Key reminders:

• Do not send reconsideration requests to the dispute inbox.
• Submit requests using the Claims Reconsideration Form available on the Claims and Rates Information page.
• Follow the steps listed under the “Claims Reconsideration Process” section.
• Visit the Claims and Rates Information page  to access the form and process steps.

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.

Prior Authorization Form

• Manual Authorization Request Form
• The Manual Authorization Request Form is to be used for the following situations:
  • The ProAuth/TruCare system is not available and is not expected to be available for an extended period. For example: 4 hours or more; this information will be communicated via the Partners website.
  • The Provider is an out-of-network and/or non-participating provider who is serving a Partners member who either requires specialty treatment not available in the network, is out of the catchment area when a crisis occurs or lives in another catchment area, but Medicaid is not expected to change. For example, members living in residential situations outside of the Partners catchment area but continue to have Medicaid from one of Partners counties.
  • A service is being requested that is not in the Partners Benefit Plan and is not an available drop-down option for services in the ProAuth/TruCare system. For example, an EPSDT Medicaid request for a service not included in the Partners Medicaid Benefit Plan.
    

Personal Care Services Request Form

• Partners DHB-3051 form (PDF) should be completed by the member’s primary care provider or physician.
• Fax the completed form to Partners at 704-457-5261
• Once this form is completed, a member of our team will contact you within 30 days to schedule a face-to-face meeting to complete your assessment.
• After the assessment has been completed and the start date has been determined, an authorization will be created/submitted by Carolina Complete Health (CCH) and will be shared with the Provider agency.
• Providers will receive notification of authorization via ProviderCONNECT.
• View the Personal Care Services Clinical Coverage Policy
• If you have questions related to PCS, please submit them to Partners_PCSInquiry@PartnersBHM.org
• Partners website: Personal Care Services
  

• Payspan is an innovative web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs), also known as 835s. 
• By using Payspan, you can speed up the processing and payment of your claims.
• Payspan: A Faster, Easier Way to Get Paid (PDF)
• To contact Payspan: Call 1-877-331-7154, Option 1 – Monday thru Friday 8:00 am to 8:00 pm est.
• Note: In November of 2022, Zelis, a company modernizing the business of healthcare, completed the acquisition of Payspan. Read on for more details. Providers should continue using the Payspan payment portal.