Building on the ongoing successes of the NC Child and Family Improvement Initiative, and with stakeholder feedback from a sample of residential providers, the LME/MCOs have created a standardized, statewide referral form (some providers may call it an application) for use by all Residential Providers and Therapeutic Foster Care (TFC) providers who contract with them. This […]
Category: Access to Care and Utilization Management
At Partners, we think of ourselves as an MCO…a Member Care Organization™.
The system of care we manage is shaped by the choices of our members and their families and designed to meet the unique needs of each of the communities we serve.
Members who need care and support can reach Partners through our Access to Care department. ACCESS manages a 24-hour crisis line and enrolls members with Partners.
Partners’ Utilization Management department authorizes the delivery of medically necessary services for our members.
Partners State-funded Service Request & Waiting List Form
Link to the Partners State-funded Service Request & Waiting List Form
Access to Care, Member Eligibility and Enrollment
PartnersACCESS PartnersACCESS is responsible for a 24-hour, seven days a week, 365-day-a-year behavioral health screening, triage, and referral service for citizens needing mental health, substance use, or intellectual and developmental disability services. All calls are answered live, in real-time, by a PartnersACCESS representative. Please note: The HOPE line is dedicated to assisting members in need [...]
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Utilization Management
The Utilization Management (UM) department ensures that individuals have equitable access to appropriate care across the Partners catchment area.
Hospitals Working with Partners
Partners works with a number of hospitals to provide inpatient services for enrollees. This section contains information for hospital providers.
Referrals to Specialty Treatment
Partners’ Utilization Management Department has separate referral processes for: Alcohol and Drug Abuse Treatment Centers (ADATC) Electro Convulsant Therapy (ECT) Hospital Inpatient Treatment Psychological Testing NC Innovations Level of Care NC Innovations Medical Assessment Alcohol and Drug Abuse Treatment Centers (ADATC) Partners’ Utilization Management has a referral process and forms for Alcohol and Drug Abuse [...]
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Service Authorization Requests
There are times when you may need to submit a SAR and ProAuth is not operational. During those times only, providers may use the Manual Service Authorization Form. Partners’ Utilization Management (UM) department’s function is to make authorization decisions by conducting initial, continuing care and retrospective reviews of services based on whether medical necessity is [...]
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Clinical Criteria Check Sheets
Clinical Criteria Check Sheets are used by Partners’ Utilization Management department to approve service authorization requests.