Issued: September 7, 2023
On March 30, 2023, Utilization Management (UM) notified providers that Partners would authorize service dates only through the end of the NC Medicaid Direct eligibility period, September 30, 2023. In a Provider Alert (https://providers.partnersbhm.org/updates-to-partners-prior-authorization-process/), Partners stated that authorizations for the remainder of the request period and units starting October 1, 2023, would be entered into TruCare by Partners UM Team.
What has changed?
The North Carolina Department of Health and Human Services (NCDHHS) delayed the launch of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans that were scheduled to begin on October 1, 2023. Funding for the implementation of Tailored Plans comes through the state budget, which has not yet been finalized and passed by the General Assembly for the current fiscal year (July 2023 – June 2024).
How does this impact providers?
This means authorizations reviewed for medical necessity criteria that were previously ended on September 30, 2023 will be adjusted to the dates/units originally requested and approved.
What if providers have questions?
Please contact UMQuestions@partnersbhm.org with any questions related to prior authorization.