Frequently Asked Questions
Partners Tailored Plan

Member General Questions

Partners Tailored Plan covers services for mental health, intellectual/developmental disabilities, substance use disorders, and physical health and pharmacy services. If you are a member of Partners Tailored Plan, it means you will continue receiving the same services you have been receiving but will now have your physical health and pharmacy services covered by Partners. If you have questions or want more information, contact Member and Recipient Services at 1-888-235-4673.

The NC Medicaid Enrollment Broker makes enrollment decisions for the Tailored Plan and sends a letter to notify members of their plan. Partners will receive the enrollment in our system and automatically mail the member a Tailored Plan letter.

Eligible members include people:

  • Who get Innovations Waiver services or are on the Registry of Unmet Needs Waiting List
  • Receiving Traumatic Brain Injury (TBI) waiver services
  • With a severe mental health condition, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI)
  • Who are on certain medications
  • With multiple chronic conditions
  • Who frequently use crisis services

Members received a letter from the NC Medicaid Enrollment Broker informing which plan they are in; they will also receive a mailing from Partners. Individuals with Medicaid will receive a new Medicaid ID card. If you are in the Tailored Plan, you will receive an ID card from Partners. It will be a white, square card with the Partners logo. NC Medicaid Direct members will receive an ID card from the state. It will be a gray, rectangular card.

You will receive a welcome packet mailed to your home. The welcome packet will include a welcome letter, a handbook, an ID card (if you are on Medicaid) and several other pieces of information. If you are a Tailored Plan member and have Medicaid, you will receive a new, white Medicaid ID card. You will now have all your medical services managed by Partners: mental health, substance use disorders, intellectual/developmental disabilities, physical health and pharmacy. You will be able to access transportation services, get extra benefits like Teledoc, and have access to a Nurse Advice line (1-888-369-2452) and Pharmacy line (1-866-453-7196). Our Member and Recipient Services staff can help you understand your benefits at 1-888-235-4673.

All dually insured Medicaid and Medicare members who have Innovations are enrolled in the Tailored Plan and will have services just like they always have. Medicare pays first; then Medicaid is the last payor. This means your medical doctor and pharmacy will bill Partners Tailored Plan Medicaid after Medicare pays. Members must notify both their medical and pharmacy providers of their new insurance with Partners so they have it on file.

There are some Medicaid services that Partners Tailored Plan does not cover. These services are covered for you by the NC Medicaid Direct program. You can get these services from any provider who takes Medicaid:

  • Dental services
  • Services provided or billed by local education agencies that are included in your child’s Individualized Education Program, Individual Family Service Plan, second 504 Accommodation Plan, Individual Health Plan or Behavior Intervention Plan
  • Fabrication of eyeglasses, including complete eyeglasses, eyeglass lenses and ophthalmic frames

If you have questions or need help with accessing benefits you can only get through NC Medicaid Direct, talk with your primary care provider (PCP) or call Member and Recipient Services at 1-888-235-4673.

To move out of a Tailored Plan and to a Standard Plan, the member must call the Medicaid Enrollment Broker and ask to move to a Standard Plan. The member will be required to acknowledge that they understand there are some services that are available only in the Tailored Plan.

Enrollment Broker
Hours of Operation: Monday – Saturday, 7 a.m. – 5 p.m.

Call: 1-833-870-5500; TTY: 711 or RelayNC.com
Website: ncmedicaidplans.gov
Mobile app: NC Medicaid Managed Care

You can ask the Enrollment Broker about:

  • Changing health plans
  • General questions about NC Medicaid Managed Care
  • Technical support for website or mobile app

Members can request to move to the Tailored Plan by calling the Enrollment Broker at 1-833-870-5500; TTY: 711 or RelayNC.com Their provider may also submit the form for them. Both Partners Tailored Plan and all Standard Plans have a Transitions of Care Team that can help with transitions between health plans.

If the member is in a Standard Plan, they should contact their current provider with questions and concerns.

Partners does not offer passes at this time. Members can ask their local YMCA for reduced cost memberships. It may be covered for members on the Innovations waiver, but they would need to speak to their care manager.

Tailored Care Management Questions

Tailored Care Management (TCM) is intensive care management. The assigned TCM coordinates both the behavioral and physical health services for a member.

Some members who are not in the Tailored Plan can receive short term care management to address immediate needs. Members who are in NC Medicaid Direct are eligible for TCM.

You can call the Member and Recipient Services line at 1-888-235-4673. This line is available anytime. Our staff will be able to look up this information for you and notify the care manager.

You can call the Partners Member and Recipient Services line at 1-888-235-4673. They will help you choose another TCM provider.

Yes. You can have this conversation with your current care manager or ask to speak to the care manager’s supervisor. We understand this is a working relationship, and it is important that you feel comfortable working with your assigned care manager.

Your TCM can address any behavioral and physical health needs, as well as assisting with resources for unmet health needs (housing, food, etc).

Care management entities are already providing TCM for I/DD.

The intensity of the TCM is entirely up to the needs and preferences of the member. Talk to your TCM and let them know what frequency works for you.

TCM services should not be affected by Tailored Plan launch. Most physicians and pharmacies are contracted with Partners for the Tailored Plan.  If yours is not, please work with your TCM or call Member and Recipient services at 1-888-235-4673 for assistance.

Pharmacy Questions

Effective July 1, 2024, members assigned to Partners Tailored Plan can take their new Partners Medicaid ID card to the pharmacy of their choice. The pharmacy process their prescriptions and updated their records in the pharmacy system. There is no need for the member to change pharmacies.

Pharmacies must be credentialed with NC Medicaid and in Partners network. You would need to prefill prescriptions you will need while out of state.

Primary Care Providers (PCP) Questions

If your primary care provider (PCP) did not sign up for the Tailored Plan, you would have been auto assigned to a contracted primary care provider. Your assigned PCP is listed on the membership card that was mailed to you. You can request to change your PCP, but as of now, members are assigned to providers who have contracted with Partners’ Tailored Plan. The member handbook tells you how to change your PCP.  You can access the member handbook online by clicking here. You can also complete the PCP Change Form. Click here.

The provider you want to see would submit a request to Partners asking to provide the service as an out of network provider. Partners would then determine the medical necessity and work to contract the provider as an out of network provider.

Of course, please give us the information and let us know who they are and where they are located so that we can outreach. You can email Jaleesa Cole at JCole@PartnersBHM.org or Beth Lackey at BLackey@PartnersBHM.org.

Non-Emergency Medical Transportation (NEMT) Questions

Modivcare is Partners’ Non-Emergency Medical Transportation (NEMT) vendor. You can schedule a ride to your appointments by calling 1-833-577-2309. Have your Medicaid ID card in hand when you call. You may also call Member and Recipient Services at 1-888-235-4673 and select Option 3 for Transportation Services.

You can arrange for transportation no more than 30 days in advance, but no less than two business days before your appointment.

Modivcare will ask for a physical address to pick up the member. If not picked up on time, members can call Modivcare to determine where the driver is and Modivcare can try to arrange for same day appointment or reschedule. Members can also download Modivcare’s app for ease of tracking driver and getting in touch with Modivcare.

NEMT is available to and from day treatment. Anyone under the age of 18, unless emancipated, requires an adult person to ride with them. This person can be a guardian, caregiver or family member. Some day treatment agencies are working on their own transportation it is suggested to contact the day treatment provider to see if arrangements have been made.

Member Medicaid ID Card Questions

You would have to call the Medicaid Enrollment Broker to discuss this with them as they make enrollment decisions.

Enrollment Broker
Hours of Operation: Monday-Saturday, 7 a.m.-5 p.m.

Call: 1-833-870-5500; TTY: 711 or RelayNC.com
Website: ncmedicaidplans.gov
Mobile app: NC Medicaid Managed Care

Call the Enrollment Broker to ask about:

  • Health plan enrollment or changes
  • General questions about NC Medicaid Managed Care
  • Technical support for the website or mobile app

There are a few ways to get a Member ID card:

Provider General Questions

Partners Tailored Plan covers services for mental health, intellectual/developmental disabilities, substance use disorders, and physical health and pharmacy services. Providers can call our Provider Services line at 1-877-398-4145, 7 a.m.-6 p.m., Monday-Saturday. Providers who wish to join Partners’ Provider Network, should:

  • Contact Partners at 1-877-398-4145 for behavioral health contracting
  • Contact our physical health partner, Complete Health Network, at 1-833-552-3876 (choose Provider Services, then option 8 for Contracting)
  • Enroll with NC Medicaid through NCTracks, the statewide credentialing system for North Carolina. This enrollment makes you eligible to contract with Partners depending on the services you want to provide.
  • Contact us at PAS@PartnersBHM.org if you are already in the network and need assistance

New providers receive a welcome packet once they have contracted with Partners.

We value our relationships with our providers. We know that your success results in better outcomes for those we serve. To help you, we offer training on specific topics and other tools to help you succeed such as our secure provider portal, ProviderCONNECT, which serves as a one-stop shop for all your needs.

Click here to read a Provider Communication Bulletin that answers this question.

Providers log in to ProviderCONNECT, our secure provider portal. Once in ProviderCONNECT, the provider should select Behavioral Health Claims or Physical Health Claims. This will allow providers to electronically submit claims.

This information was provided in an information session conducted with Carolina Complete Health, our partner for physical health network contracting. Click here to view the information.

Partners will continue to contract with providers for the NC Medicaid Direct plan, which means we will authorize and pay for behavioral health, intellectual/developmental disability and substance use disorder services for members who do not meet Tailored Plan criteria. For those members who meet the Tailored Plan criteria, we will be responsible for their full healthcare – behavioral health, intellectual/developmental disability and substance use disorders, as well as transportation, physical health services and pharmacy. This is a true ability to treat and care for a person holistically. For more information, please refer to our training information on the Training Resource and Collaborative (TRAC) page, which includes great resources for providers, members and families to learn more.

The Tailored Plan also includes services for recipients who do not have Medicaid. State funds can be used for populations who do not meet the criteria for Medicaid.

We have materials focused on what is available for recipients on our website under the Recipients tab.

The NC Medicaid Enrollment Broker makes enrollment decisions for the Tailored Plan and sends a letter to notify members of their plan. Partners will receive the enrollment in our system and automatically mail the member a Tailored Plan letter.

Eligible members include people:

  • Who get Innovations Waiver services or are on the Registry of Unmet Needs Waiting List
  • Receiving Traumatic Brain Injury (TBI) waiver services
  • With a severe mental health condition, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI)
  • Who are on certain medications
  • With multiple chronic conditions
  • Who frequently use crisis services

Members received a letter from NC Medicaid Enrollment Broker informing them of which plan they are in; they will also receive a mailing from Partners. Individuals with Medicaid will receive a new Medicaid ID card. If you are in the Tailored Plan, you will receive an ID card from Partners. It will be a white, square card with the Partners logo. NC Medicaid Direct members will receive an ID card from the state. It will be a gray, rectangular card.

If a member moves to a county outside of Partners’ 15-county service area, we are notified by a disenrollment report from the state. Our Transition of Care (TOC) team works with the member’s new plan by staffing the member information to coordinate care. Click here for details.

Members in NC Medicaid Direct will continue to receive (b)(3) services. Tailored Plan members will need to transition to 1915(i) services.

To get an Alpha+ login or to schedule Alpha+ training, contact Partners Information Technology Service Desk at 1-704-842-6431. Each staff member will need their own unique Alpha+ Provider Portal login. You may also contact the Service Desk if you currently have a login and are having difficulties with the login.

Click here to reference the Clinical Coverage Policies.

The only physical health residential is adult care home. If someone has severe mental health issues and physical health issues, they may potentially be eligible for Transitions to Community Living (TCL) program to divert from an adult care home.

Provider Tailored Care Management Questions

Tailored Care Management (TCM) is intensive care management. It can address a member’s behavioral and physical health needs and assist with resources for unmet health needs. The assigned TCM coordinates both the behavioral and physical health services for a member.

The member will be able to receive (b)(3) services until transitioned to the 1915(i) services. Partners is aware of all members that still need to transition and is working with providers and TCM to facilitate the transition.

Care management entities are already providing TCM for I/DD.

Identifying a member’s care manager is quick and easy. Call the Member and Recipient Services line at 1-888-235-4673. This line is available at any time. Our staff will be able to look up this information and share it with you. They will also be able to notify the care manager so they may follow up.

Updated: July 2, 2024

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