Partners Tailored Plan Provider Resources
Contact Us and Resources
- Partners Provider Services Line: 1-877-398-4145
- Partners Member & Recipient Services: 1-888-235-HOPE
- Partners Behavioral Health Crisis: 1-833-353-2093
- Carolina Complete Health Network Provider Engagement Team
- Tailored Plan Information for Partners Providers
Training and Resources
- Partners Physical Health Provider General Education (PDF)
- Additonal Partners Provider Trainings
- Partners Out-of-Network (OON) Provider Guide (PDF)
- Partners Durable Medical Equipment Provider Guide (PDF)
- This document and process does not apply to the NC Innovations Waiver service T2029 Assistive Technology Equipment & Supplies (ATES). For questions on ATES, please contact the member's Partners Health Management Care Manager.
- Personal Care Services Provider Companion Guide (PDF)
Partners and Carolina Complete Health will host office hours for Partners Tailored Plan physical health providers. We will use the time to share pertinent updates related to the topics and specialty areas below as well as hear from you and answer any questions you may have.
Office Hours sessions will be held every three weeks on Tuesdays at 12PM. Please register for the sessions that you would like to attend. If you would like to register for more than one session, you must register separately.
- 9/10: Personal Care Services focus. Intended audience: Any provider billing for PCS, including adult care homes and in-home PCS. View slides (PDF) and recording.
- 10/01: Utilization Management focus with tips and best practices for submitting authorizations. Intended audience: all physical health Partners providers. View slides (PDF) and recording.
- 10/22: Prenatal Programs available for Partners members. Intended audience: Advanced Medical Homes, FQHCs, and Health Departments. View slides (PDF) and recording.
- 11/12: Home Health Provider topics. Intended audience: All Home Health Care Services Providers.
- 12/3: Hot Topics/General Education and Q&A Intended audience: all physical health Partners providers.
Provider Portal
Physical Health providers that are enrolled with Partners Tailored Plan will utilize ProviderCONNECT, Partners' Section 508 and HIPAA-compliant secure provider portal.
Partners ProviderCONNECT Portal SetupProviders receive a login to ProviderCONNECT when they join the network and name a local administrator for the portal.
This individual is responsible for setting up your organization’s accounts in ProviderCONNECT and will serve as the point of contact with Partners. Click here for more information.
Action needed:
- Determine if your organization has established a Local Administrator: Local Administrators
- If yes, connect with your site's local admin to be added as a user.
- If no, designate a a local administrator at your organization and proceed with the below instructions.
- Local Administrator Set-up:
- Designated portal administrators must complete Partners Health Management ProviderCONNECT set-up form
- Once you complete the survey, you will receive an email from Partners in 1-2 business days with next steps.
- For questions about this form please contact credentialingteam@partnersbhm.org.
- Local Administrator Instructions:
Provider Forms
Claim Reconsideration
- If dissatisfied with the Claims Processing outcome, Providers can complete the Reconsideration Form. Claims Analysts will review claims submitted on the form for accuracy and provide the research outcome. If dissatisfied with the outcome of the Claims Reconsideration, Providers have the option to File a Grievance/Complaint.
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
Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)
- 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.
Claim Submission
Physical health claims for Partners Tailored Plan members are processed by Carolina Complete Health.
View Partners Claims Submissions Information and Billing Guide on the Claims and Rates Information page.
You can submit physical health claims in any of the following ways:
| Method | Claim Submission Instructions |
|---|---|
| Portal | ProviderCONNECT then choose Physical Health Claims to submit Physical Health Claims; this brings you to Availity. |
| Partners Health Management PO Box 8002 Farmington, MO 63640-8002 | |
| Clearinghouse/EDI | Provider’s Clearinghouse connection to Availity for Claims processing. |
| Payer ID | 68069 |
Please complete the Provider Hardship Request Form located on Partners' webpage for Finance Documents and Forms.
Partners Prior Auth Flexibilities
To alleviate provider administrative burden during the launch of Tailored Plans, Partners will initiate a No Prior Auth period for Medical Services rendered between 7/1/2024 and 1/31/25. *This exception does not apply to concurrent reviews for inpatient hospitalizations, which should still occur during this time period.
For additional details, please review Partners’ Communication Bulletin #152 located on the Partners Provider Knowledge Base.
Pre-Auth Tool
To check on a specific physical health service or procedure for Partners Tailored Plan members, use the Pre-Auth Tool. Providers should also review the Clinical Coverage Policy for specific details on services and procedures.
Partners Pre-Auth Tool
Authorization Submission
Physical health authorizations are reviewed by Carolina Complete Health. Please use one of the following methods to submit a physical health PA.
| Method | Physical Health PA Submission Instructions |
|---|---|
| Portal | Log into ProviderCONNECT then use ProAuth to submit web authorizations |
| Fax | Use the Fax Form and submit to one of the following:
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Non-emergent, Advanced, Outpatient Imaging Services
- In an effort to continue promotion of quality improvement for services provided to Partners members, effective July 1, 2024, Partners will use Evolent, formerly known as National Imaging Associates, Inc. (NIA) to provide the management and prior authorization of non-emergent, advanced, outpatient imaging services.
- Services managed and authorized by NIA include outpatient:
- CT/CTA
- CCTA
- MRI/MRA
- PET Scan
- MUGA Scan
- Myocardial Perfusion Imaging (MPI)
- Stress Echocardiography
- Echocardiography
- Please visit Evolent's website for Partners Health Management to download policies and procedures specific to both ordering providers and imaging facilities. These include quick reference guides and FAQs. You can also view information designed to assist you in using the RadMD Website to obtain and check authorizations