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:
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:
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:
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.
Covered services by our in-network vision providers include services provided by ophthalmologists and optometrists.
This includes:
You can find a provider at partnersbhm.org/provider-search/. From the “Find a Provider” home page, select Physical Health, then either Provider Practice or Clinician. (If you are looking for a provider location or group, select Provider Practice. If you are looking for a particular doctor, select Clinician.) Select the county or counties where you would like to see a doctor. Under services scroll to ophthalmology, optometrists or opticians. Select what you want to search. (You may select more than one choice.) Hit the “View Results” button. Give it a few minutes and you will receive a list of available providers. If you don’t see what you expect, you can contact questions@partnersbhm.org or call Member and Recipient Services at 1-888-235-4673.
You may have an injury or an illness that is not an emergency but still needs prompt care and attention. Whether you are at home or away, you can walk into an Urgent Care Clinic to get care the same day or make an appointment for the next day. If need help making an appointment, call your PCP or Partners Nurse Advice Line 1-888-369-2452 (24 hours/day).
Examples of why you might visit an Urgent Care Clinic include:
Yes, you may use it as a Partners Tailored Plan benefit 1-800-835-2362. You may register at teladochealth.com/benefits/nc-partners or by calling the number and asking for assistance. Please register for this before you need it.
Dental services are carved out of the Tailored Plan but are still a Medicaid benefit. You may receive services from any dentist who is contracted with NC Medicaid. Search here under NC Medicaid Direct ncmedicaidplans.gov/en/find-provider.
The North Carolina Medicaid dental program covers preventative, restorative, periodontal and orthodontic dental services, as well as oral surgeries and dentures. Adults and kids alike can find dentists who accept North Carolina Medicaid at ncmedicaidplans.gov/en/find-provider.
You will need to use the provider search tool on Partners website to select a provider for durable medical equipment (DME). You will then need to ask the individual’s PCP to write an order to the DME provider for the needed health supplies. Your Tailored Care Manager can also assist you in acquiring health supplies.
To find a DME provider:
Check our business hours on the contact page. If you ever have a question outside of these hours, don't hesitate to reach out!
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.
You may discuss your benefits with your Tailored Care Manager. If you do not have a tailored care manager, you may email our Member Engagement team at memberquestions@partnersbhm.org.
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.
Call the Pharmacy line at 1-866-453-7196 and ask them to escalate it to the Helpdesk. To ensure you do not have other past insurance still showing active in the Medicaid system, you may first call NC Medicaid’s third-party insurance management contractor, Health Management Systems, at 1-866-263-2227, option #3. They will be able to term the third-party insurance that is showing. It can be a long wait but there is an option to have them call you back. If you continue to have issues, contact the NC Medicaid Help Center at 1-888-245-0179.
You may only fill up to 90 days of your medication and will have to have someone pick them up after that and mail them to you.
Please contact the CVS Caremark Pharmacy Line: 1-866-453-7196
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.
Yes, this would be allowed under continuation of benefits.
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.
Inform the PCP that per NC Medicaid, you do not have to have your ID card; they can verify your benefits from your Medicaid number in NC Tracks.
There are rules in place to help make this move easier for you and to avoid disrupting your care as much as possible. You may keep seeing the Medicaid providers you see now until Jan. 31, 2025 – even if they are not listed on your health plan ID card. You can change your PCP for any reason until Jan. 31, 2025. (If you see a new provider for the first time, they must accept your Tailored Plan.)
Your coverage for your medicines also stays the same until Jan. 31, 2025. Your dental coverage will not change. This means you can keep seeing the dental providers you see now; dental coverage will not change.
Your new Primary Care Provider will not show up in the Medicaid system (NC Tracks) until the first day of the next month, but you can see any PCP in our network without the PCP being assigned. This means you can go ahead and start seeing your new PCP before you receive your updated card.
If your primary care providers (PCP) did not sign up for the Tailored Plan, you were 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.
Please provide your doctor’s information. If we know who they are and where they are located, we can outreach to try to get them into Partners’ network. You can email Jaleesa Cole at JCole@PartnersBHM.org or Beth Lackey at BLackey@PartnersBHM.org.
Check our business hours on the contact page. If you ever have a question outside of these hours, don't hesitate to reach out!
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.
Yes, they can ride at no cost.
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.
Check our business hours on the contact page. If you ever have a question outside of these hours, don't hesitate to reach out!
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:
There are a few ways to get a Member ID card:
Contact Member and Recipient Services at 1-888-235-4673, TTY: 711.
Partners will mail a new Tailored Plan Medicaid ID card five days after the request and change is processed. Sometimes, we can immediately mail a new card (example: request for a duplicate card with no changes). Other times, the changes you request will have to be sent back through the system and may take a little longer. Once the changes are processed, Partners will mail your new card within five days. Cards are mailed through the United States Postal Service. Actual delivery of the card is dependent upon your mail delivery.
Check our business hours on the contact page. If you ever have a question outside of these hours, don't hesitate to reach out!
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