There are times when you may need to submit a SAR and AlphaMCS is not operational. During those times only, providers may use the Manual Service Authorization Form.

Partners’ Utilization Management (UM) Department’s function is to make authorization decisions by conducting initial, continuing care and retrospective reviews of services based on whether medical necessity is substantiated in the request for authorization. The UM Department utilizes guidelines based on the North Carolina Division of Medical Assistance (DMA) Clinical Coverage Policies and Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) State Funded Service Definitions.

Providers will submit a Service Authorization Request (SAR) via AlphaMCS to request delivery of services to individuals.  A Service Authorization Request must include:

  • Provider name and site code for where services to be offered
  • Authorization date range
  • Services requested per Benefit Plan (Medicaid B, Medicaid C, Medicaid B3, and State)
  • Guardian/relationship to individual
  • Individual’s disability: Mental Health, Intellectual and Developmental Disabilities, Substance Use
  • ASAM level is required for all individuals with a substance use and co-occurring disorders that include a substance use diagnosis
  • LOCUS/CALOCUS scores for individuals with a mental health diagnosis only and co-occurring disorders that include a mental health diagnosis
  • NC-SNAP or Supports Intensity Scale for Individuals with Intellectual or Developmental Disorder
  • Primary Care Physician and release of information
  • Medications dosage, frequency, and compliance with medications
  • ICD-10 diagnoses
  • Substance use details
  • Justification for services (provider comments)
  • Uploaded documents as indicated on the current benefit plan

Providers can see reviewer comments in comments section. If additional information is requested by UM, and when possible, the provider has five days to respond to the request. Failure to respond could lead to the request being administratively or clinically denied.