Issued:  November 5, 2019

December Provider Webinar Rescheduled to Tuesday, December 10, 2019

Partners’ December Provider Webinar has been rescheduled. The December Provider Webinar will be held on Tuesday, December 10, 2019, at 1 p.m.

If you have already registered for this event, make sure to note the date change. You do not need to re-register.

If you have not registered for the December Provider Webinar, please visit to register and view information from previous provider webinars.

Changes to Medicaid-Funded Peer Support

Effective November 1, 2019, Peer Support Services will be available in the Medicaid B Benefit Plan. Peer Support will not be offered as a B3 Service.  The new codes for this service are:

  • H0038—Peer Supports Individual
  • H0038 DJ—Peer Supports Individual (DOJ)
  • H0038 HK—Peer Supports Individual-Timely Follow Up
  • H0038 HQ—Peer Supports Group
  • H0038 HQ DJ—Peer Supports Group (DOJ)

The following codes will be discontinued as of October 31, 2019:

  • H0038 HKU4
  • H0038 HQU4
  • H0038 HQU4DJ
  • H0038 U4
  • H0038 U4DJ

 Clinical Coverage Policy 8G and Partners Benefit Plan indicate that:

  • The program is under the direction of a full-time Qualified Professional (QP)
  • Maximum program staff ratios are the following:  QP to Certified Peer Support Specialist (CPSS) is 1:8; CPSS to beneficiary is 1:15; CPSS Group Facilitator to beneficiary is 1:12 for Peer Support Group
  • The Peer Support Specialist must be certified by the NC Peer Support Specialist Certification Program
  • Beneficiaries are eligible for sixty-four (64) unmanaged units once per episode of care in a state fiscal year
  • Prior approval is required for Peer Support Services provided beyond the unmanaged unit limitation
  • A service order must be signed by a physician or other licensed clinician, per his or her scope of practice, prior to or on the first day service is rendered
  • A Comprehensive Clinical Assessment is required to determine medical necessity of service prior to initial authorization request
  • Clinical information must be obtained and documented in the beneficiary’s Person-Centered Plan prior to initial authorization request
  • Peer Support may be provided in the beneficiary’s place of residence, community, in an emergency department or in an office setting
  • Peer Support is not a first responder service.  Peer Support service providers shall coordinate with other service providers to ensure “first responder” coverage and crisis response

Partners Utilization Management will require a CCA and PCP to be submitted for Medical Necessity review for initial authorization after the use of unmanaged units.  Providers may request up to 270 units per 90 days Initial Authorization and 270 units per 90 days during subsequent reauthorization periods, if medically necessary.  Additional units may be authorized if clinically appropriate.

Attention Mental Health and Substance Use Disorder Providers:  Authorization Calculator

The date range calculator in AlphaMCS is undergoing revision. In order to ensure that units requested for date range are accurate, providers should use the MH/SUD Authorization Calculator located at and submit requests for the “Total Units per Authorization.

Providers with additional questions related to date range calculations in AlphaMCS may contact the MH/SU Utilization Management Workgroup at 704-842-6436 or the Inpatient Workgroup at 704-842-6434.

Provider Search Usability Testing

Partners’ new Provider Search is now in its testing phase. The search tool is available at and includes new features, such as

  • the ability to search by agency or licensed independent practitioner name
  • new search parameters, such as specialty, county, gender and more

Partners ask that you share the link to the new Provider Search with members and ask them to

You can also access the Provider Search by visiting, selecting Member in the top menu, and clicking on Provider Search (beta).

Please note:  Providers that find incorrect information for your agency/practice during testing should email  with the corrected information. Members that find incorrect information or have questions should email