In this bulletin:
Physical Health Updates
The Partners Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan collaborates with Carolina Complete Health (CCH) to support physical health providers participating in the Tailored Plan. The Partners/CCH Special Bulletin offers valuable guidance on enrollment, claims processing, authorizations and compliance requirements.
CMS Prior Authorization Timeline Change, Effective July 1, 2026
Effective July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) will implement new prior authorization (PA) response time requirements for all providers.
- Standard PA requests will be processed within seven calendar days, reduced from the current 14-day timeframe, with an extension of up to 14 calendar days permitted in certain circumstances.
- Expedited/urgent PA requests will continue to be completed within 72 hours.
What This Means for Providers
Providers can expect faster turnaround times for standard PA requests. Because timeframes will be shorter, providers are encouraged to submit all required clinical documentation with the initial authorization request. Incomplete clinical information may result in denial due to insufficient supporting records.
For more information about submitting authorizations, visit Partners’ Prior Authorization information page.
Specialized Outpatient Therapies: PA Clarifications
CCH completes reviews for outpatient specialized therapies on behalf of Partners. CCH uses an “umbrella authorization” approach to simplify the authorization process:
- Authorizations are issued under a primary, or “umbrella,” Current Procedural Terminology (CPT) code for each therapy discipline.
- Once approved, the authorization also applies to other related treatment codes within the same discipline.
- Providers should continue to specify in the plan of care which treatments are being used.
- Separate authorizations are not required for each treatment code.
- Each therapy discipline authorization will show only one CPT code and is approved based on visits, not units.
- Providers must still submit the usual documentation, including:
- Signed orders
- Evaluation and plan of care
- Progress notes for continued services
| Primary Authorization Codes | |||
| Therapy Type | Authorization (“Umbrella”) Code | Applicable CPT Codes | Modifier |
| Occupational Therapy | 97530 | 97110, 97112, 97116, 97140, 97530, 97533, 97535, 97760, 97761, 92065 | GO |
| Physical Therapy | 97110 | 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97035, 97036, 97110, 97112, 97113, 97116, 97124, 97140, 97530, 97533, 97535, 97760, 97761, 97763 |
GP |
| Speech Therapy | 92507 | 92507, 92508 | GN |
For more information or questions, contact Utilization Management
- Physical Health UM questions: PHUMQuestions@PartnersBHM.org
Provider Training and Office Hours
Partners and CCH host office hours for Partners Tailored Plan physical health providers on the first Tuesday of each month at noon.
Providers are encouraged to register and submit questions in advance.
Archived sessions are available on CCH’s Partners Tailored Plan Provider Resources page.
Questions
For more information related to Physical Health Utilization Management, contact PHUMQuestions@PartnersBHM.org.
Pharmacy Updates
Preferred Fenofibrate and Denosumab
When prescribing fenofibrate and denosumab, providers should refer to the NC Medicaid Preferred Drug List (PDL) to ensure the correct tablet strength and formulation or biosimilar is ordered.
Preferred products include:
- Fenofibrate 48 mg and 145 mg tablets, generic for Tricor®
- Bildyos® Syringe, denosumab-nxxp, biosimilar to Prolia
Review the NC Medicaid Preferred Drug List for more information.
Clozapine Management Training
Providers are reminded to sign up for A New Era in Clozapine Management, a free, on-demand, seven-module educational series hosted by the Schizophrenia & Psychosis Action Alliance (S&PAA) in collaboration with the American Association of Psychiatric Pharmacists (AAPP).
The training supports safe, confident and effective clozapine prescribing in the post-REMS era. Participants may complete any or all modules at their own pace. Participants can earn continuing education credit through seven expert-led modules designed to help providers:
- Strengthen skills in initiation, monitoring and adverse effect management.
- Address considerations for special populations.
- Integrate patient perspectives into care.
- Apply evidence-based and real-world strategies to improve outcomes.
Register for A New Era on Clozapine Management on the AAPP website.
Breast Cancer Screening Initiative
Partner with us to improve early detection and save lives.
Breast cancer screening, especially mammography, is one of the most effective ways to detect cancer early. Partners is encouraging providers to help eligible members complete recommended breast cancer screenings by identifying members who are due, discussing the importance of screening and helping reduce barriers to care.
Why It Matters
Early detection can lead to better outcomes and improved survival. Many eligible members are overdue for screening, and a provider recommendation is one of the strongest drivers of screening adherence.
Providers can help by:
- Identifying women aged 40 and older who are due for screening.
- Recommending screening at every appropriate visit.
- Addressing common barriers such as fear, cost concerns or scheduling challenges.
- Simplifying access by helping patients schedule or complete referrals.
- Following up with patients who are overdue or who miss scheduled screenings.
Barriers to Screening
Some members may face barriers that make screening harder to complete. Common barriers include poverty, lack of insurance, stigma, language differences, immigration concerns, physical access needs, communication challenges or past trauma.
Individuals with a history of trauma or abuse may find screening procedures triggering, invasive or painful. Establishing trust is essential; patients may experience fear, anxiety, embarrassment or mistrust because of past trauma, cultural beliefs, communication barriers or low health literacy.
Providers can support trauma-informed screening by:
- Introducing themselves at each interaction.
- Asking permission before physical contact.
- Explaining procedures in advance.
- Providing choices whenever possible.
- Fostering a supportive, therapeutic relationship.
- Modifying the environment to improve comfort.
- Offering translation services when available.
- Offering female providers when possible.
- Allowing a trusted support person to be present.
Small changes in communication and environment can help patients feel safer, more respected and more prepared to complete recommended screenings.
Alternative Screening Options
Mammography remains a key screening tool. However, for individuals who cannot tolerate standard mammography due to discomfort, positioning challenges or other concerns, alternative screening methods should be considered, including:
- Diagnostic ultrasounds
- Breast MRIs (Magnetic Resonance Imaging)
- Clinical breast exams
- Advanced imaging technologies
Providers should discuss options with patients based on clinical need, accessibility, comfort and available services.
Key Messages for Patients
Providers are encouraged to share clear, simple messages with patients, including:
- Mammograms can detect breast cancer early, often before symptoms appear.
- Routine screening saves lives.
- Screening is quick, important and often covered.
Together, we can make a difference. Recommend, refer and follow up.
Resources
Find a Partners Physical Health Provider
Partners’ Prevention and Population Health Programs webpage.
References
Baylor College of Medicine. (n.d.) Breast health and disability. https://www.bcm.edu/research/research-centers/center-for-research-on-women-with-disabilities/a-to-z-directory/breast-health
Bedford Breast Center. (n.d.). Mammogram alternatives: Understanding your breast cancer screening options. https://www.bedfordbreastcenter.com/blog/mammogram-alternatives-understanding-your-breast-cancer-screening-options/
Center to Advance Palliative Care. (2023, May 10). How to provide the best care for patients with intellectual and developmental disabilities. https://www.capc.org/blog/how-to-provide-the-best-care-for-patients-with-intellectual-and-developmental-disabilities-idds/
Indiana Department of Health. (2022, July). Breast and cervical cancer screening and trauma-informed care. https://www.in.gov/health/cdpc/cancer/early-detection-bccp
Journal of Medical Imaging and Radiation Sciences. (2023, September 6). Making mammography inclusive for patients with disabilities. https://www.jmirs.org/article/S1939-8654(23)01818-0/fulltext
MCD Global Health. (n.d.). Breast cancer screening practice considerations. https://mcd.org/screening-for-all/resources/breast-cancer-screening-practice-considerations
National Breast Cancer Foundation. (2026, April 20). Breast cancer facts & statistics. https://www.nationalbreastcancer.org/breast-cancer-facts/
National Institutes of Health. (n.d.). Strategies for accessible breast screening for people with disabilities. https://pmc.ncbi.nlm.nih.gov/articles/PMC11075611/
Simmons University. (2016, January 14). Alternatives to mammograms. https://online.simmons.edu/blog/alternatives-to-mammograms/
SurvivingBreastCancer.org. (2025, October 15). The challenges of breast cancer screening with a disability. https://www.survivingbreastcancer.org/post/breast-cancer-screening-and-disability-not-as-simple-as-it-seems
New Member Trainings
Partners now offers live physical health educational trainings for members. Providers are encouraged to share these opportunities with members, families and caregivers who may benefit from learning more about preventive care, children’s health, maternal health, nutrition and diabetes.
Available Trainings
Health Checkups Adults Need to Stay Healthy
This course explains why adults need regular checkups to stay healthy. Participants will learn which medical tests are important at different ages, what each test does and how screenings can help prevent health concerns or identify them early. The course also explains how Partners can support members in their health journey.
Health Checkups Children & Youth Need for Healthy Growth
This course explains why regular checkups are important for children and youth. Participants will learn how doctors monitor growth, identify health concerns early and help children stay healthy for school, sports and everyday life. The course also covers vaccines and why they matter.
Maternal Physical Health: Healthy Mom, Healthy Baby
This presentation helps participants understand pregnancy, common pregnancy terms, body changes and possible complications. Participants will learn about the importance of speaking up, asking questions, eating healthily during and after pregnancy, and how supporting people can help throughout pregnancy.
Nutritional Health: Why Good Food Choices Matter
This course explains why healthy eating matters and how different foods affect the way the body feels and works. Participants will learn about important nutrients, the impact of unhealthy food choices and simple ways to make healthier food choices.
Understanding Diabetes
This training explains what diabetes is, the different types of diabetes, common signs, risk factors and what can happen if diabetes is not treated. The training also covers how some mental health medications can affect diabetes, ways to help prevent diabetes and how to manage care.
Providers can view upcoming live member trainings on the Partners Training website.
To request a member education session for your organization, support group or advocacy group, complete the Member Education Request Form.
Current Service Needs
Partners has identified the following service gaps. Providers are needed across our 15-county service area. For details, forms and updates, visit the Current Service Needs page.
Priority Service Gaps
Clinically Managed Residential Withdrawal Services (Social Setting Detoxification): Clinically managed residential withdrawal services, also referred to as a social setting detoxification, are organized, facility-based services that provide 24-hour supervision, observation and support for members who are intoxicated or experiencing withdrawal. Services are delivered by appropriately trained staff and focus on monitoring, stabilization and referral to ongoing treatment as needed. This service is needed for NC Medicaid Direct and Tailored Plan.
Ongoing Needs
- Multidisciplinary Evaluation (MDE) Court-ordered, comprehensive assessments for guardianship proceedings (medical, psychological, social work; other disciplines as needed).
- Psychological Evaluation and Interpretation Standardized testing and interpretation to inform treatment selection and planning; may include psychosocial assessments and goal-directed psychotherapy for children and adolescents.
How to Participate
- Review requirements and next steps on the Current Service Needs page.
- Already in the Partners network? Complete the Provider Change Form.
- Not yet in the network? Submit the Request for Consideration Form.
- NCTracks required: Your agency, NPI, taxonomy, sites and clinicians must be enrolled in NCTracks to contract with Partners and make contract changes.
Claims Information
To help avoid payment delays, duplicate submissions, recoupments and misrouted requests, providers are reminded to review the following claims guidance.
Avoid Claim Delays
Partners has observed an increase in claims status inquiries from clearinghouses. Providers using a clearinghouse for claim reconciliation must ensure that their staff have access to remittance advice. Providers are also reminded to follow these claim submission requirements:
- Submit each benefit plan on separate claims.
- Include all diagnosis codes on claims. Diagnosis codes help Partners measure member health, identify areas of risk and evaluate the quality of care.
Prevent Duplicate Claims
Partners has recently observed an increase in duplicate claims. To help prevent duplicate submissions, providers should:
- Check claim status before resubmitting.
- Allow enough processing time to avoid premature resubmissions.
- Submit corrections correctly using the proper frequency code.
- Review denial reasons and fix issues before resubmitting.
- Use claim tracking tools to monitor status and next steps.
Submit Physical Health Paper Claims
Physical Health paper claims should be mailed to:
Partners Health Management
Attn: Claims
PO Box 8002
Farmington, MO 63640-8002
Respond to EOB Requests
Partners requests copies of Explanation of Benefits (EOB) documents for members/claims submitted with Coordination of Benefits. Requests will be sent by email from Partners Claims staff. When an EOB is requested:
- Submit the information by secure email before the date specified in the request.
- If a response is not received, the original claim payment will be recouped.
Follow the Claims Reconsideration Process
Partners has seen an increase in claims reconsideration requests sent to the Provider Dispute email inbox, which may delay processing. To ensure requests are handled quickly and correctly, providers should follow the Claims Reconsideration Process outlined on the Partners website. Providers should:
- Not send reconsideration requests to the dispute inbox.
- Follow the steps listed under the “Claims Reconsideration Process” section on the Claims and Rates Information page.
- Access Availity® in ProviderCONNECT under the “Physical Health Claims” Quick Links box for Physical Health claims.
For all claims-related questions, providers should contact the Claims Department at ClaimsDepartment@PartnersBHM.org. To avoid delays in receiving a response, do not contact individual claims staff directly.
Check Eligibility and Enrollment
For eligibility and enrollment questions, providers are encouraged to contact the Eligibility and Enrollment Department at EligibilityEnrollment@PartnersBHM.org.
To request enrollment, providers should visit Alpha+ Home Page > Enrollments. For guidance, refer to University > Provider Portal Handbook > Enrollments.
If additional enrollment training is needed, email EligibilityEnrollment@PartnersBHM.org to schedule one-on-one training. Providers must have Microsoft Teams screen-sharing capabilities for more specific and in-depth training.
Request State Benefit Health Plans
Providers now have the option to request appropriate State Benefit Health Plans (AMI, ASTER, etc.) with a future date. Providers may request this 60 days prior to the current end date.
Clinical Coverage Policies
Utilization Management uses clinical coverage policies to administer benefits and determine medical necessity. Service definitions and clinical policies guide when and how services are covered for physical health, behavioral health, substance use disorders (SUD) and intellectual/developmental disabilities (I/DD). Read more on the Service Definitions page on the Partners Provider Knowledge Base. For questions, email UMQuestions@PartnersBHM.org.
IRIS Incident Reporting Reminders
All providers of publicly funded services are required to submit Level II and Level III incident reports in the North Carolina Incident Response Improvement Center (IRIS) within 72 hours of becoming aware of the event. This applies to:
- Category A Providers: Providers of publicly funded services licensed under NC General Statutes 122C, except hospitals.
- Category B Providers: Providers of publicly funded non-licensed periodic or community-based mental health, developmentally disabled and/or substance abuse services.
Recent Provider Alerts
Training Resource and Collaborative (TRAC)
TRAC offers a centralized cross-functional selection of required training, collaboratives and events. TRAC provides a centralized hub for cross-functional required training, collaboratives and events. Please note: the way you register for TRAC trainings and meetings has recently changed. Click here to view what is coming up and register.
Community Training
All Trainings are Virtual via Zoom and are two hours unless otherwise specified. Participants may not be admitted to the training if joining more than 15 minutes after the training begins. Participants who request a certificate will need to be on camera during the training. For more information, contact: Amber Matthews, AMatthews@PartnersBHM.org.
Understanding Diabetes
July 8, 2026 | 2 – 3 p.m. (Register)
This training explains what diabetes is and the different types of diabetes. It covers common signs, things that can raise the risk of getting diabetes and what can happen if diabetes is not treated. The training also talks about how some mental health medications can affect diabetes, ways to help prevent it and how to take care of yourself if you have diabetes. Participants will learn how to get help and where to find more information.
Women’s Health
July 8, 2026 | 2 – 4 p.m. (Register)
During this training we will discuss women’s health topics across the lifespan from adolescent to senior years. The focus of this training is to highlight the cumulative experience of reproductive, physical and mental health for women.
Non-Suicidal Self-Injury
July 9, 2026 | 10 a.m. – noon (Register)
Learn about non-suicidal self-injury, what causes people to injure themselves, warning indicators and what we can do when we encounter someone who self-injures.
Wellness and Wellbeing
July 9, 2026 | 2 – 4 p.m. (Register)
Let’s get together and talk about developing habits that support a healthier, more balanced life. This interactive training touches on mindfulness, resilience, stress reduction techniques and self-care strategies. We will discuss practical tools to improve daily functioning and long-term wellbeing.
Nutritional Impact on Mental Health
July 10, 2026 | 10 a.m. – noon (Register)
Join us for an insightful training on the intricate relationship between eating behaviors and mental health. This interactive training will explore how our dietary choices and habits can profoundly influence our mental well-being, emphasizing the crucial connection between nutrition and mental health.
Mental Health 101
July 14, 2026 | 10 a.m. – noon (Register)
Learn about mental wellness, potential signs and symptoms of mental health challenges and some of the common behavioral health disorders. The training also includes information about treatment and what to do in a crisis. *Disponible en Español
Diabetes 101
July 14, 2026 | 2 – 4 p.m. (Register)
Diabetes 101 training provides a comprehensive overview of diabetes, including its types, signs, symptoms, risk factors and potential complications. Participants will gain knowledge about diabetes prevention, self-management strategies and valuable resources to support those affected by the condition.
Community Resiliency Model (CRM)®
July 15, 2026 | 10 a.m. – noon (Register)
The Community Resiliency Model® (CRM) teaches participants about the impact of trauma and chronic stress on the nervous system, behaviors and long-term health. Participants learn how to reset the nervous system with easy-to-learn, concrete coping skills resulting in resilient communities.
Question, Persuade, Refer (QPR) Suicide Prevention
July 15, 2026 | 2 – 4 p.m. (Register)
This evidence-based training teaches the skills to recognize warning signs of suicide and intervene in a suicide crisis. “Ask a question, save a life.” *Disponible en Español
Internet Safety
July 16, 2026 | 10 a.m. – noon (Register)
Children are spending more time online than ever before- learning, gaming and connecting with friends. This training equips parents and caregivers with practical tools and knowledge to help children learn to navigate the internet safely and responsibly. Participants will learn about online risks, including inappropriate content, sextortion and cyberbullying, as well as strategies for setting healthy digital boundaries.
Maternal Physical Health: Healthy Mom, Healthy Baby
July 16, 2026 | 3 – 4 p.m. (Register)
This presentation helps participants understand what pregnancy is and what happens during each stage. It explains common pregnancy words, what to expect as the body changes and things that can cause problems during pregnancy. Participants will learn about possible pregnancy complications, the importance of speaking up and asking questions and how to eat healthily during and after pregnancy. The presentation also explains how partners can support someone throughout pregnancy.
Human Trafficking: Keeping Our Children Safe
July 17, 2026 | 10 a.m. – noon (Register)
Human Trafficking is a global problem, even in the United States. Children may be susceptible to online predators. Learn about trafficking around the world and resources to keep our children safe.
Hypertension
July 21, 2026 | 2 – 4 p.m. (Register)
This training provides overview of high blood pressure, including prevention, early detection, risk factors and complications. Participants learn self-management strategies and how to use community and online resources to support heart health.
Community Café
July 22, 2026 | 10 – 11 a.m. (Register)
One of the core values of the System of Care is collaboration among community agencies. Community Collaboratives in each of our counties promote collaboration, share resources, and identify needs of the community. This month we highlight the collaboratives in each of our counties. Hear about the focus and projects in each county and how to join a collaborative.
Active Listening/De-escalation
July 22, 2026 | 2 – 4 p.m. (Register)
This training focuses on active listening skills, empathy and habits to keep yourself and other people safe. There will be discussion about how our own experiences impact our ability to assist others in high-stress situations.
Maternal Mental Health
July 23, 2026 | 2 – 4 p.m. (Register)
This training delves into the nuances of maternal mental health, perinatal mood disorders and practical tools for support. Explore the essential intersection of mental health, pregnancy/postpartum care and social determinants of health while gaining insights that contribute to creating a nurturing environment for mothers.
Caring for the Caregiver
July 24, 2026 | 10 a.m. – noon (Register)
Caring for a loved one can be meaningful but it can also be physically and emotionally exhausting. This training explores the signs and symptoms of burnout, common stressors and the impact of prolonged stress on overall well-being. Participants will gain practical tools for setting healthy boundaries, managing stress and sustaining themselves while continuing to care for others.
Emotional Intelligence (EQ) Essentials
July 27, 2026 | 2 – 4 p.m. (Register)
This training introduces the core components of emotional intelligence and teaches practical skills to manage emotions, improve communication and build strong relationships in daily life and work.
Substance Use: Overview, Recovery & Resources
July 28, 2026 | 10 a.m. – noon (Register)
This training explains substance use disorder, its health impacts and effects of common substances. Participants learn how to recognize signs, support recovery and connect people with helpful local and online resources.
Nutritional Health: Why Good Food Choices Matter
July 28, 2026 | 11 a.m. – noon (Register)
In this course, you’ll learn why healthy eating matters for you and the people around you. You’ll discover how different foods affect the way your body feels and works. We’ll talk about important nutrients your body needs to stay healthy and what can happen if we eat too much unhealthy food. You’ll also learn simple tips and ideas to help you make better food choices so you can stay strong, feel good and be your best.
Trauma Part Two: Trauma Informed Care
July 29, 2026 | 2 – 4 p.m. (Register)
We will look at how our behavior affects others who have a history of trauma and learn about the elements of trauma informed care. *Trauma Informed Care Probation/Parole and Trauma Informed Care for Schools available upon request.
Introduction to Child and Family Team (CFT) Training (Part 1)
Aug. 5, 2026, and Aug. 6, 2026 | 9 a.m. – 4 p.m. (Register)
This System of Care training is a two-day, 11-hour experiential training. Child and Family Team training provides an overview from the family’s perspective. The training seeks to reinforce the idea of “one family, one plan” by addressing CFT through the lens of multiple systems. *Offered quarterly either virtually