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April 15, 2015

Important Contract and Certificate of Insurance Information


All Providers are required to submit the following information, as soon as possible, for renewal of contracts.

In Provider Communication Bulletin #42 (issued March 26, 2015), Partners requested that all provider agencies inform us of the name and email of the current authorized contract signer for the agency. Partners uses electronic signature software, therefore contracts, renewals, amendments, and/or extensions will be emailed directly to the staff who is responsible for signing.

All provider organization must complete a form that identifies the 
authorized contract signer's name and email address
for your organization. 
Click here to access the form. Complete the form and email it to by 5 p.m., Friday, April 17.

In addition, all Providers,  or their insurance agent must ensure that a current Certificate of Insurance (COI) has been forwarded to Partners. The COT should be addressed to Partners BHM, 901 S. New Hope Rd., Gastonia NC 28054.
  • Insurance Certificates may be:
    •  Emailed to:
    •  Faxed to: 336-527-3265
    •  Mailed to Partners BHM, 901 S. New Hope Rd.,
       Gastonia NC 28054
Please note that:
  • Partners BHM should be listed as additional Insured
  • Insurance limits must meet or exceed contract requirements
  • Contracts will not be renewed if insurance on file has expired

If you have any questions regarding the contact form or certificates of insurance, please email or call 336-527-3295.



About Partners Behavioral Health Management
Partners Behavioral Health Management (Partners BHM) provides local management of publicly-funded behavioral health services in Burke, Catawba, Cleveland, Gaston, Lincoln, Iredell, Surry, and Yadkin counties. Offices are located in Elkin, Hickory, and Gastonia. Individuals in need of behavioral health services can call our Customer Service call center 24 hours a day, seven days a week at 1-888-235-HOPE (4673).
Want to learn more about Partners? Visit


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