Issued:  May 14, 2020


Prior Authorizations

Partners announced in Provider Communication Bulletin #103 that effective March 19, 2020, Partners lifted the requirement to obtain prior authorization for services provided to members during the COVID-19 crisis period.  Partners has now extended this period through June 30, 2020. Providers can continue to initiate, continue to deliver, and bill for services.

  • The number of units that were approved in the most recent authorization will stay the same.
  • All services should reflect Medically Necessary care.
  • Upon the first concurrent authorization after this period, all documentation must be submitted to Utilization Management according to the Service Definition and additional guidance from NC DHHS.
  • Flexibilities given to Innovations recipients through Appendix K will remain in place in accordance with Appendix K timelines

Services billed during this period for dates of service prior to March 19, 2020, are subject to pre- or post-payment review. Claims may be denied/recouped due to no authorization.

Claims Processing Information

Beginning July 1, 2020, the authorization edit will be enabled.

What this means for providers and claims processing:

  • Any claims submitted after June 30, 2020, will deny if there is no authorization and an authorization is required for the procedure code.
  • Claims dated March 19, 2020-June 30, 2020, will be manually processed if the claims deny for no authorization only.
  • We encourage providers to submit claims as soon as possible to prevent claims from going through the manual process. This will ensure provider claim reimbursement in a timelier manner.

Monitoring Site Visits

Partners has made the decision to suspend all routine monitoring, including virtual, until June 30, 2020. We will reassess as conditions are changing daily. This includes monitoring for unlicensed Alternative Family Living; post-payment reviews and credentialing site visits (initial and re-credentialing). Partners will offer the provider the opportunity to virtually complete any reviews that the Partners Quality Management (QM) Monitoring department currently has in process. If the provider cannot complete the review at this time, providers will be offered the opportunity to reschedule.

Feedback Requested: Service-Related Flexibilities

Partners is seeking feedback from providers to share with the State on the existing COVID-19 service-related flexibilities.

Services to be assessed in this survey are State Funded Services

  • Telehealth
  • In-Lieu of Services
  • I/DD and Innovations Services
  • Clinical Coverage Policies 8C and 1H
  • RB-BHT
  • Enhanced Services
  • (b)3 services

Please indicate whether you would like to continue flexibilities or discontinue services.  If you do not provide the service, select N/A

Please submit your feedback by close of business Friday, May 15, 2020. Click here to access the survey

Service Codes S5145 and S5145HA Flexibilities

In partnership with providers, and in a review of Special Bulletin COVID-19 #46,the following flexibilities apply to service codes S5145 and S5145HA

  • Waive reauthorization.
  • Waive staff training requirements unable to be performed during the state of emergency, except sex offender specific training.
  • Allow sex offender training to occur virtually.
  • Allow QP, licensed professional, psychologist, psychiatrist to provide treatment and consultation via telehealth and/or telephonically, as clinically indicated and based on level of expertise, instead of providing on-site at the facility.
  • All supervision and daily structure services must be provided in-person by the appropriate staff.

Providers should continue to bill these codes and document the flexibilities based on this guidance.  These flexibilities are retroactive to March 10, 2020 as indicated in the NC Medicaid Special Bulletin.

Joint Communication Bulletin #JCB365

On May 14, 2020, DMH/DD/SAS and DHB issued Joint Communication Bulletin #JCB365, IDD Supported Employment Guidance, which helps agencies that provide IDD supported employment services make informed decisions about COVID-19 and minimize the risk of exposure to individuals served and staff.  Retroactive to March 13, 2020, LME/MCOs may apply the same flexibilities to State-funded IDD Supported Employment and Long-Term Vocational Supports as those allowed under the NC Medicaid Inn ovations Appendix K to the extent funding is available.