Provider Enrollment/Credentialing

Medicaid Credentialing and Re-Credentialing Criteria (Revised 11/28/2012)

IPRS Credentialing and Re-Credentialing Criteria  (Revised 11/28/2012)_

Questions? Submit Provider Enrollment Questions Here

Provider Enrollment/Credentialing Instructions

Sandhills Center (SHC), a Local Management Entity (LME) has been selected as a North Carolina Medicaid 1915 (b/c) waiver site. The original implementation date was scheduled for July 1, 2012. The implementation has been revised to be effective December 1, 2012. The 1915 (b/c) Waivers establish the Sandhills Center Network as a single Prepaid Inpatient Health Plan (PIHP) through which mental health, substance abuse, and developmental disabilities services will be authorized and paid.

After December 1, 2012, SHC will handle all authorizations and payments to providers for all appropriately delivered Medicaid services for Medicaid enrollees from the eight SHC counties.

Effective December 1, 2012, behavioral health service providers serving Medicaid enrollees from the eight SHC counties will no longer be working with Value Options for authorizations.  

Medicaid providers (including individual practitioners, agencies, clinics or hospitals) located in or out of SHC’s eight county catchment area will not be able to continue receiving Medicaid authorization or payment for services for residents from the eight SHC counties under their current fee for service agreements.

In order to continue as a provider for a SHC enrollees/member who is a Medicaid recipient, behavioral health care providers must submit an application. Please note: Neither a current contract with SHC nor a current service agreement with Medicaid will waive the requirement for enrollment with SHC. If the application is received later than ninety (90) days prior to the LME-MCO "go live" date (December 1, 2012), the application will be processed in the order which it is received; however, there is no assurance that it will be processed by the "go live" date. In this case, the provider must develop a plan to transition consumers in the event that the provider cannot be enrolled in the LME-MCO network.

As of December 1, 2012, any enrollees/members of providers who are not enrolled/credentialed in the Sandhills Provider Network as either a Medicaid and/or IPRS Provider will be offered a choice of another provider who is a current enrolled/credentialed member of the Sandhills Provider Network.

The provider enrollment/credentialing process includes the following steps:

  1. Complete the application. Refer to Selecting an Application to determine which application is appropriate to your circumstances.

  2. Print the application as a single sided document for signature by a legally Authorized Representative

  3. Retain a copy of your completed Application packet and all documentation submitted for your records.

  4.  Review, print, and sign the Trading Partner Agreement

  5. Submit completed applications and Trading Partner Agreement as stipulated on Application title page.

You will receive written notification (e-mail or letter) within 10 days regarding the status of your application.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sandhills Center

A Local Management Entity - Managed Care Organization
of the NC Department of Health and Human Services

Victoria Whitt- Chief Executive Officer

 

 

Links

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