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Provider Alert: Duplicate Checkwrite

Issued: October 31, 2022 Partners Health Management identified claims that were paid twice on the October 25, 2022 checkwrite. Recoupments for overpayments will begin on the November 1, 2022 checkwrite. Please contact claimsdepartment@partnersbhm.org if you have questions.

Updated Standard Rate Schedules: Vaya Partners Rates Revisions Effective Oct. 1, 2026

Vaya Health and Partners Health Management will merge Oct. 1, 2026, to form Vaya Partners. Updated select standard rates for all behavioral health Medicaid and non-Medicaid (State-funded) services are now posted on the Vaya Partners website at VayaPartners.org. They are also accessible through Vaya’s Rate and Checkwrite Schedules webpage and the Partners Claim and Rates

Eligibility and Enrollment

Partners Health Management wants providers to be aware of the process for contacting Eligibility and Enrollment ahead of its pending merger with Vaya Health on Oct. 1, 2026. Providers should use the designated Eligibility and Enrollment (E&E) support lines and contact information below, rather than calling E&E staff on their direct phone lines. This will

Utilization Management Provider Portal Training for Today Cancelled

The Utilization Management Provider Portal Authorizations training scheduled for 1-2 p.m. today, Sept. 24, 2026, has been cancelled. We apologize for any inconvenience. Please refer to the Vaya Partners ProviderCONNECT portal training schedule below, which will continue throughout October. For more information, email provider.training@vayahealth.com.   General Provider Portal Overview and Navigation: Tuesdays, 1-2 p.m. –

Updates to Innovations IFDS Employer of Record Model

Effective Oct. 1, 2026   Vaya Health and Partners Health Management will merge to form Vaya Partners on Oct. 1, 2026. At that time the following changes will be effective. CAP Waiver self-directed care models transitioning to NC Innovations Individual & Family Directed Supports (IFDS) Employer of Record Model (EOR) Vaya Partners offers choices to

NC Innovations Provider Quarterly Self-Review of Member Record Requirement is Changing

Effective Oct. 1, 2026 The NC Innovations Waiver requires that Care Managers monitor implementation of the member’s care plan / individual support plan, using a standardized monitoring check list. When Vaya Health and Partners Health Management merge on Oct. 1, 2026, to form Vaya Partners, NC Innovations Waiver providers will experience changes in submitting quarterly

Provider Communication Bulletin #180

In This Bulletin: Vaya Partners Merger Updates Provider Training Updates NC-TOPPS Updates EPSDT Services Reminder Increased Choking Episodes Clinical Coverage Policies Recent Provider Alerts PDF Version> Vaya Partners Merger Updates Vaya Health and Partners Health Management are preparing to merge effective Oct. 1, 2026, to form Vaya Partners. Please note the following merger-related updates. Provider

Peer Support Services (CCP 8G) Clinical Coverage Policy Update

Partners Health Management is notifying providers of updates to NC Medicaid Clinical Coverage Policy (CCP) 8G: Peer Support Services, which became effective Sept. 1, 2026. NC Medicaid has published a revised version of the policy that includes updates to the service definition, eligibility and medical necessity criteria, authorization requirements, service orders, documentation standards, provider responsibilities,

Authorization Requests for Dates of Service Beginning Oct. 1

In preparation for the upcoming Oct. 1, 2026, merger of Vaya Health and Partners Health Management (Partners), Tailored Plan and NC Medicaid Direct member eligibility has changed in NCTracks to Vaya Partners. This change is resulting in providers receiving invalid eligibility messages when trying to enter authorization requests in ProAuth for dates of service beginning

Changes in Copays

Starting Oct. 1, 2026, some members will see a difference in how pharmacy copays are applied. This change is to align and be consistent with North Carolina’s Medicaid copay rules. As a result, some  members with an intellectual/developmental disability (I/DD) will have a $4 copay when they fill a prescription. Not every member with I/DD

Updated Vaya Partners Standard Rate Schedules Available

Vaya Partners’ standard rate schedules will go into effect Oct. 1, 2026, for the entire Vaya Partners network. Rate schedules and a procedure codes crosswalk are posted to the new Vaya Partners website at VayaPartners.org. Please note the following schedules have been updated: Medicaid Clinician Services, Medicaid 1915(c) NC Innovations Waiver, and Non-Medicaid (State-funded) Clinician Services.