Benefits

Benefit GridsPre-Authorization Lookup Tool Benefit Grids The following Benefit Grids outline service codes, service limits, level of care and documentation requirements needed for service authorization requests (SARs). They also outline requirements for unmanaged services.  Medicaid and State Benefit Grids Service Pre-Authorization Lookup Tool Partners' Service Pre-Authorization Lookup Tool provides authorization requirements by service code. We [...]
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Service Definitions

The official posting of mental health, substance use disorder and intellectual and developmental disability service definitions are found within the various clinical coverage policies published by the NC Division of Medical Assistance. These definitions are located on DMA’s Clinical Coverage Policy web page, which includes, but is not limited to, the following clinical coverage policies: [...]
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Clinical Practice Guidelines

Partners has adopted Clinical Practice Guidelines from the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. Providers are responsible for following the Clinical Practice Guidelines adopted by Partners. Adherence to the guidelines is monitored through: Focused audits by Partners’ Quality Management Department Routine reviews of Service Authorization Requests (identifying areas of concern) [...]
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Cultural Competency

A culturally competent approach to services requires that we all examine and potentially transform each component of mental health, substance use, and intellectual and developmental disability services.

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EPSDT

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a federal Medicaid requirement. The NC Division of Medical Assistance (DMA) is required to cover services, products, or procedures for Medicaid beneficiaries under 21 years of age if the service is medically necessary health care to correct or […]

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Evidence-Based Practices

Evidence-based practices are interventions, treatments and programs that have proven effective in producing specific positive outcomes. These methods have been studied and are confirmed to produce positive changes in individuals.

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