Hospitals Working with Partners

Partners works with a number of hospitals to provide inpatient services for enrollees. This section contains information for hospital providers.

Hospitals interested in joining the Partners Network should email Providers@PartnersBHM.org.

Partners requires prior authorization for inpatient admissions. Hospitals seeking to admit a Partners’ enrollee for inpatient psychiatric treatment should call the UM Hospital Admissions Team at 704-842-6434. Staff is available 9 to 7 p.m., seven days a week.

Details regarding authorization can be located in the Partners’ Provider Operations Manual and the Hospital Behavioral Health Facility Instructions Manual.

░ Quick Links:

Emergency Department Reimbursement Form Special Project Enrollment Form

Inpatient Document/Form Information Grid

► Hospital Behavioral Health and Acute Care Facility Instructions ◄

 

 

Document Information	Frequency of Submission	Forms and Document Links	How to Submit to Partners
Out of Network Hospital Single Client Inpatient Application/ Agreement This three-pages document serves as the contractual agreement for the inpatient services.	Each admission/episode of care per enrollee	Out of Network Hospital Consumer Specific Agreement Inpatient Review Form	Send via Secure email to providers@partnersbhm.org
Inpatient Review Form	At admission and per benefit plan limits until discharged	Inpatient Review Form	Send via Secure email to providers@partnersbhm.org OR Information can be given via telephone interview with UM reviewers at 704-842-6434 7 days per week 8 a.m.-7 p.m.
Manual Service Authorization Request (SAR)	At admission and per benefit plan limits until discharge	Manual Service Authorization Form	Send via Secure email to providers@partnersbhm.org OR Information can be given via telephone interview with UM reviewers at 704-842-6434 7 days per week 8 a.m.-7 p.m.
Copy of Certificate of insurance for General & professional liability, automobile coverage as applicable, workers comp	Each admission/ episode of care per recipient. Should cover the dates of service of the admission	N/A	Send via Secure email to providers@partnersbhm.org
Hospital-Based Clinician Registration  Worksheet	Each Admission/episode of care per recipient if attending physician services are billed as part of inpatient services by hospital	Hospital-Based Clinician Registration Worksheet	Send via Secure email to providers@partnersbhm.org
Trading Partners BHM Agreement – Used only if filing claims using HIPAA compliant transactions.	Submitted one (1) time and kept on file unless there are changes.  If already submitted for other services such as Emergency Department services, does not have to be submitted again unless there are changes.	Trading Partner Agreement OR Will be mailed by Finance staff with fully executed out of network agreement for the facility’s first agreement submitted	Send via Secure email to providers@partnersbhm.org OR Mail directly to: Partners Behavioral Health Management 901 South New Hope Road Gastonia, NC  28054 Attn: IT Department
W-9	Each admission/episode of care	N/A

 

Updated: June 8, 2023