Provider Enrollment/Credentialing

LIP CAQHNC Credentialing and Recredentialing App to Participate as a Health Care Provider (PDF)

LIP CAQHNC Credentialing and Recredentialing App to Participate as a Health Care Provider (Word)

Medicaid Credentialing and Recredentialing Criteria (PDF)

 Medicaid Credentialing and Recredentialing Criteria (Word)

IPRS Credentialing and Recredentialing Criteria (PDF) 

IPRS Credentialing and Recredentialing Criteria (Word)

LIP Recredentialing (PDF)

LIP Recredentialing (Word)

Agency-Facility Recredentialing (PDF)

Agency-Facility Recredentialing (Word)

Hospital Recredentialing (PDF)

Hospital Recredentialing (Word)

Provider Recredentialing

Sandhills Center requires recredentialing of all Network Providers every three years. 

You will receive notification from Sandhills Center Network Operations to complete the applicable Recredentialing Application(s) (Agency, LIP or Hospital) and submit supporting documents.  Failure to return a completed application within the time required, may delay review of your application, which may also result in a lapse in your participation in the Sandhills Center Network. 

Please be reminded that Sandhills Center is a closed network.  You are being recredentialed for services that are currently on your contract. You are to select on the application those services that you are currently providing.  The recredentialing process does not allow you the opportunity to add additional services or change your contracted funding source(s).

As a part of the recredentialing process, Sandhills Center will also review any provider performance concerns within the network, including any information collected through the Sandhills Center Quality Management Department.

During the recredentialing process, you will have the right to:

1.      Be informed upon request of the status of your recredentialing;

2.      Be notified of information that is significantly different than reported by you and to have the opportunity to correct erroneous information in writing

You may be enrolled with the Council for Affordable Quality Healthcare (CAQH). This data source will suffice for some of your recredentialing requirements. However, there may be required information that will not be available with CAQH that you’ll be required to submit in addition to your CAQH application information. If you are a participating provider with CAQH, and authorize Sandhills Center to access your information, please let us know. We will retrieve your information for review and contact you for any additional information.  You may register with CAQH at no cost by visiting www.caqh.org/cred/.

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

Sandhills Center Resources

Provider Directory

AlphaMCS Provider Portal

CABHA

IPRS Provider Manual FY2013-2014

 

Medicaid ProviderManual 2013-2014

Provider Memoranda

FY 2012-2013

FY 2011-2012

Provider Forms

Finance/Claims

Provider Enrollment/Credentialing

Incident Reporting

QuarterlyProviderMeetings

Upcoming Meeting Dates
Agenda

Provider Orientation

Agency
Hospitals,Physicians,& Solo LIPs

Provider Training Schedule

NC-TOPPS Training

Cultural Competency Plan / Resource Booklet

Provider Satisfaction Survey

Regulatory Compliance

Medicaid Fraud
DHHS Poster
Public Service Message

Zixmail Training

State Resources

Division of MH/DD/SAS

Communications Bulletins
Medicaid Bulletins
Training Programs
Implementation Updates
Service Definitions
NCTOPPS
NC SNAP
Supports Intensity Scale

Division of Medical Assistance

HIPAA Transaction Companion Guides

Health Service Regulation

Community Care of NC

NC LME Regions by Counties

Veterans Focus

Other Resources

NAMI

SAMHSA