Issued: March 30, 2023
Effective April 1, 2023, Partners Medicaid benefit plan will transition to NC Medicaid Direct. The Tailored Plan eligibility start date has changed to October 1, 2023.
What is happening:
Partners is authorizing service dates only through the end of the current NC Medicaid Direct eligibility period, September 30, 2023.
When is this happening:
The change is effective April 1, 2023.
How does this impact providers?
- Utilization Management (UM) will continue to complete medical necessity reviews for all requested service dates and units.
- Providers and Tailored Care Managers should continue to submit authorization requests for the service dates and units needed.
- Authorizations with end dates after September 30, 2023, will be adjusted by UM to end on September 30, 2023. (Units will be adjusted to be in line with end date September 30, 2023.)
- The Authorization Rationale statements on electronic Authorizations and Manual Authorizations will reference all approved service dates and units. When the electronic authorizations are able to be entered, they will end on September 30, 2023, with adjusted units.
- Authorizations for the remainder of the request period and units starting October 1, 2023, will be completed as administrative approvals closer to October 1, 2023.
- These changes DO NOT apply to State Funded Services. State authorizations should be submitted under the current process.
What if providers have questions?
Please contact UMQuestions@PartnersBHM.org with any questions related to prior authorization.