Information for Providers of Services

Sandhills Center is committed to insuring the provision of quality services and supports to consumers with mental health, developmental disabilities, and substance abuse needs. Inherent to this, is consumer choice and a community of providers that are responsive to consumer needs and preferences.

Sandhills Center Network Operations will provide information in a timely manner  to ensure that providers have access to all state and federal regulations, Division guidelines, and training opportunities for the continued development and maintenance of quality and efficient services for our consumers.

Sandhills Center B-3 Physician Consultation/ Psychiatric Consultation

(Adult Mental Health/Child Mental Health)

Medicaid Billable

02-25-2014

Communication between a primary care provider and a psychiatrist for a patient-specific consultation that is medically necessary for the medical management of psychiatric conditions by the primary care provider. This service is coverable under the State Plan under physician services.

 A consultation service that provides brief, intermediate and extensive levels of consultation between a Psychiatrist and a Primary Care Provider to ensure appropriate management of psychiatric conditions by the Primary Care Provider. The individual must be a patient of the primary care provider. The Psychiatrist may or may not observe the individual as appropriate as a component of the consultation. This consultation may take the form of email, telephone, fax or face-to-face communication.

 Staffing Requirements

 Primary Care Provider or Board Certified in Adult or Child Psychiatry and holds a current license in the state of NC.

 Service Type/Setting

Psychiatric Consultation is a periodic service intended to ensure that Primary Care Providers have access to appropriate consultation to meet the medical needs of individuals with mental health conditions. Services provided to individuals that are independently seen by a psychiatrist should be billed under psychiatric CPT codes. This service may be provided in the office of the psychiatrist, the primary care provider office or an adult care home.

 Program Requirements

This service will be delivered by Psychiatrists that are contracted and credentialed by SHC and meet the provider qualification policies, procedures, and standards established by the Division of MH/IDD/SA Services and the requirements of 10A NCAC 27G. These policies and procedures set forth the administrative, financial, clinical, quality improvement, and information services infrastructure necessary to provide services.

Utilization Management

This service does not require prior approval. The amount, duration, and frequency of the service must be included with the individual’s Individual Support Plan or Service Plan.

Brief: Simple or brief communication to report tests and/or lab results, clarity or alter previous instructions, integration new information into the medical treatment plan or adjust therapy or medication regimen.

Intermediate: Intermediate level of communication between the psychiatrist and the primary care provider. Does not require face-to-face assessment of patient. To coordinate medical management of a new problem in an established patient, evaluate new information and details and/or initiate a new plan of care, therapy or medication regime.

Extensive: Complex or lengthy communication, such as prolonged discussion between the psychiatrist and the primary care provider regarding a seriously ill patient, lengthy communication needed to consider lab results, response to treatment, current symptoms or presenting problem. Staffing of case between psychiatrist and primary care provider to consider evaluation findings and discuss treatment recommendations, including medication regimen.

Entrance Criteria

Must be under the care of a primary care provider, and requires a consultation between a psychiatrist and their primary care practitioner for appropriate medical or MH treatment.

Adults ages 18 and older with Serious Mental Illness and a Locus level of 0 (basic level).

Children ages 3-21 with serious emotional disturbance (SED) and a CALOCUS level of 0 (basic level).

Continued Stay Criteria

The recipient continues to meet eligibility criteria and participant needs continue to require this service.

Discharge Criteria

Primary Care Provider no longer requires assistance with the individual’s psychiatric needs.

Expected Outcomes

Amelioration or stabilization of psychiatric symptoms.

Service Documentation Requirements

Minimum standard is a daily full service note that includes the individual’s name, Medicaid identification number, and date of service, purpose of the contact, duration of the service, task addressed, support provided, and effectiveness of the intervention, provider signature and credentials of the staff person.

Service Exclusions/Limitations

This service may not be utilized for a consumer who is already under the direct clinical care of a psychiatrist.

LME/MCO Monitoring and Quality Management Protocols for Review of Efficacy and Cost-Effectiveness of Alternative Service

Sandhills Center will monitor this service for quality and fidelity to the definition through billing audit reviews.

eApplication for B-3 Psychiatric Consultation

Unmanaged Outpatient Sessions  

Victoria Whitt, CEO

March 11, 2014

Effective March 31, 2014, Sandhills Center is increasing the number of Medicaid and IPRS unmanaged visits for outpatient therapy to 24 units for both adults and children. This is an increase from the current unmanaged visit maximum of 8 sessions for adults and 16 sessions for children. Any outpatient services beyond those initial 24 units will require prior approval.

Additionally, with the transition to Alpha MCS, from the current NetSmart package, it will no longer be necessary for Sandhills Center’s Member Eligibility and Enrollment staff to link IPRS members to providers in Provider Connect. Providers will have the ability to enroll members directly. Therefore, effective March 31, 2014, ME&E staff will no longer issue IPRS service registrations in Provider Connect for initial and/or crisis services. Since providers will have the ability to enroll IPRS members directly, just as with Medicaid, initial authorizations for IPRS services will be requested through the Alpha Provider Portal just as with Medicaid services.

 

                         ICD-10 and DSM 5 Information and Links

On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.

The Centers for Medicare and Medicaid (CMS) ICD-10 site is the authoritative source of information and has many resources, work plans, webinars, and more.

Visit the  CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline.

Sign up for ICD-10 email updates to stay up to date on new ICD-10 information.

View the CMS eHealth Summit- Road to ICD-10 Webcast: “CMS ICD-10 Readiness.” (Complete the online registration to view the webinar recording.)

Road to 10: ICD-10 Training Webinar Series will focus on ICD-10 basics, key preparation steps for a successful transition, billing, and clinical documentation concepts.

ICD-10 Helpful Links

The following links take you to documents and websites that offer ICD-10 training and educational opportunities:

http://www.cms.gov/ICD10/ This website provides resources and timelines to assist providers, payers and vendors with the U.S. health care industry’s transition to ICD-10.

http://www.cms.gov/ICD10/Downloads/ICD10FAQs.pdf. ICD-10 Compliance Fact Sheet or FAQs

http://www.nchica.org/HIPAAResources/icd10.htm. This website provides resources developed by the North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA) to assist with ICD-10 implementation efforts

http://wedi.org/public/articles/dis_viewArticle.cfm?ID=904. This service offered by the Workgroup for Electronic Data Interchange (WEDI) connects the healthcare community with vendors providing ICD-10 implementation and training services.

http://www.ahima.org/icd10/. This series of links takes you to training from the American Health Information Management Association (AHIMA).

http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=473. This website offered by the Health Information and Management Systems (HIMSS) provides information on system remediation plan development, ICD-10 testing, software tools, how to select vendor partners, staff training plan, change management, communications and education plan as well as the Go Live plan.

http://apps.who.int/classifications/apps/icd/icd10training/. This website offers self-directed training for various users of the ICD-10 codes.

http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf. This legislation governs the implementation of ICD-10.

Note: The previous information is published by entities other than the NC DHHS. The State of North Carolina, its agencies, and agents are not responsible for the content.

Other On-Line Resources and Training Links:

https://www.thenationalcouncil.org/events-and-training/webinars/webinar-archive/

March 31, 2014

 Sandhills Center AlphaMCS Provider Portal Is Live  

Sandhills Center has transitioned to our new software AlphaMCS Provider Portal.
To access the system go to https://login.alphamcs.com/alphamcs/AlphaMCS.aspx#/Views/portallogin.xaml. You should have received an email with your userid and password.
Please go to the AlphaMCS Portal University at http://www.alphacm.net/portaluniversity/ and review the online training documentation.
Please contact the Sandhills Center Provider Help Desk with any questions at 1-855-777-4652 or ProviderHelpDesk@sandhillscenter.org.
Thank you.

 

All Providers are accepting new members
unless specified otherwise.

Letters from Victoria Whitt

  • (January 21'st 2014) Sandhills Center taps AlphaMCS for service improvements
    West End, NC – January 21, 2014 Sandhills Center announced today that it has selected AlphaMCS as its new software system for member enrollment, authorization of services, and billing.
    AlphaMCS was designed specifically for use by behavioral health managed care organizations such as Sandhills Center, and has demonstrated successful operations within six of the ten local management entities/managed care organizations within North Carolina, said Victoria Whitt, Chief Executive Officer of Sandhills Center.
    AlphaMCS possesses all of the automated, integrated functions necessary for a managed care environment, and is a partner in the efforts to standardize processes across LME/MCOs. “This standardization will help us and our service providers deliver more efficient care to the members we serve,” said Whitt.
    AlphaCM is very excited to expand our partnership with Sandhills Center beyond our current provider billing agent relationship,” said Kevin Ennis, AlphaCM Chief Executive Officer. “We believe that adding Sandhills to the AlphaMCS MCO family will not only strengthen Sandhills as a MCO, but will strengthen the AlphaMCS product and the rest of the MCO groups. We are dedicated to a successful implementation and improving operations for both the MCO, providers and ultimately the consumers they serve.”
    Sandhills Center will transition to using AlphaMCS in the spring of 2014.
    -END-
    CONTACT: Liz Switzer, Community Relations and Communications , 201 N. Eugene Street, Greensboro, NC 27401, 336.389.6200, lisz@sandhillscenter.org
    Sandhills Center is the local management entity/managed care organization for mental health, intellectual/developmental disability and substance abuse services in Anson, Guilford, Hoke, Harnett, Lee, Moore, Montgomery, Randolph and Richmond counties.

  • (November 4'th 2013)
    Dear Provider,

    Sandhills Center is experiencing claims adjudication system issues in light of our vendor transition from HPE to Eastpointe/NTST, effective October 1, 2013. I regret the problems and apologize for the difficulties you are experiencing as a result of this.

    We are aggressively working with our partners, NTST and Eastpointe, to resolve these issues. To date, we have identified and corrected several issues that were negatively affecting our ability to process your claims. The majority of these issues have been corrected, and processing previously submitted claims is our priority. I do appreciate your patience as we work through this backlog.

    We have identified one additional item that has an impact on payment of claims. Please know that this issue is being addressed and our vendor, NTST, is on site working to resolve it. A brief description of the issue is below.

                     • NPI numbers – For providers submitting 837s, the current claims adjudication system will only accept one billing NPI number per provider, resulting in a delay in claims processing. Providers will not have to take any further action.

    Many providers have had questions regarding receiving RAs and 835s for paid claims. The posting of RAs is currently up to date. Providers may retrieve their RAs by logging onto the Sandhills Center Web Portal and clicking on the new RA report. The new RA report can be opened with providers’ existing passwords and tax ids. We had also been experiencing issues with importing check data into our claims adjudication system. However, this has been corrected and 835s will be available early in the week of November 4th via ShareFile.

    We will continue efforts to address any issues until we are confident that the claims adjudication system is functioning according to our standards. Please also know that we will continue to work with you on an individual basis around any issues that are resulting in a financial hardship for your agency.

    Thank you for your patience during this time of transition for all of us, and thank you for all you do for our mutual consumers.

    Sincerely,

    Victoria Whitt
    Sandhills Center
    CEO

  • Provider Claims Adjudication Process Transition (8/19/2013)

  • State Funding Reductions Letter (10/19/2012)

  • Merger of Sandhills Center and Guilford Center (10/12/2012)

  • Medicaid Waiver Implementation Letter (9/17/2012)

Important announcement from Anthony Ward,
Chief Operating Officer:

NOTICE EFFECTIVE DECEMBER 1, 2012: As a 1915 (b)/(c) Medicaid waiver site Sandhills Center is no longer offering contracts to all interested providers for the current 8 county area.  Sandhills Center will enroll providers based on the needs of the local recipients and on provider network performance. Sandhills Center is an operational waiver site as of December 1, 2012 and held its open enrollment period during the months preceding implementation of the Medicaid waiver. 

NOTICE EFFECTIVE APRIL 1, 2013:   As Guilford County moved under the 1915 (b)/(c) Medicaid waiver on April 1, 2013, Sandhills Center is no longer offering contracts to all interested providers for the 9 county area.  Sandhills Center will enroll providers based on the needs of the local recipients and on provider network performance. Sandhills Center held its open enrollment period for providers serving Guilford County consumers in the months preceding the April 1, 2013 implementation of the Medicaid waiver. 

Need Answers?

Contact
Sandhills Center Provider Help Desk


Phone: 1-855-777-4652
Fax: (910) 673-0211
Email: ProviderHelpDesk@sandhillscenter.org


Help Desk Questions & Answers (12/01/13 - 12/31/13)
Help Desk Questions & Answers (11/01/13 - 11/30/13)
Help Desk Questions & Answers (10/01/13 - 10/31/13)
Help Desk Questions & Answers (09/01/13 - 09/30/13)
Help Desk Questions & Answers (08/01/13 - 08/31/13)
Help Desk Questions & Answers (07/01/13 - 07/31/13)
Help Desk Questions & Answers (06/01/13 - 06/30/13)
Help Desk Questions & Answers (05/01/13 - 05/31/13)
Help Desk Questions & Answers (04/01/13 - 04/30/13)
Help Desk Questions & Answers (03/01/13 - 03/31/13)
Help Desk Questions & Answers (02/01/13 - 02/28/13)
Help Desk Questions & Answers (01/01/13 - 01/31/13)


Archive of Past Help Desk Questions and Answers

PowerPoints from Provider Orientation

The PowerPoints below were used during the March 14, 2013, and March 26, 2013, Sandhills Center Provider Orientation.

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Training Resources

NC Council of Community Programs logo

Benchmarks Training Institute Logo

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What's New

NEW IMPORTANT: CHECK-WRITE EXTENSION FOR 4/1/14 CUTOFF SANDHILLS CENTER WILL BE EXTENDING THE CUTOFF OF 4/1/14 TO 4/3/14 TO ASSIST PROVIDERS IN GETTING THEIR BILLING IN FOR CHECK-WRITE DATE OF4/8/2014. ANY QUESTIONS, PLEASE E-MAIL billing@sandhillscenter.org  or contact your assigned Claims Specialist.

NEW Notice to Providers – Consumer Admission Forms (Originally posted 01/13/2014)

NEW Notice to Providers – Timely Filing of Claims (Originally posted 01/13/2014)

Top Provider Errors Preventing Data Entry of the Consumer Admission Form (Originally posted 09/24/2013)

ATTENTION PROVIDERS WHO SUBMIT ELECTRONIC CLAIMS: Please note that effective August 23, 2013 processed 837 files will be deleted from Sharefile. Sandhills Center will no longer maintain process 837 files within Sharefile.
Thank you. (Originally posted 08/20/2013)

Notice to Providers – Discharge Summaries (Originally posted 09/03/2013)

Notice to Providers – Online Mistakes (Originally posted 07/29/2013)

Vacancy Announcement for Network Leadership Committee (Originally posted 07/29/2013)

May 2013 Provider Meeting Questions and Answers (Originally posted 07/10/2013)

ATTENTION: Due to the length of the VO authorizations, billing instructions for Foster Care and Provisional/Associates has been modified:
If you have Value Option authorizations that extend past the 4/01/13 Guilford Medicaid Waiver start date, you will need to continue to use the Guilford information as the billing provider until your VO authorization expires. Once you request a TAR in Provider Connect you will need to start using Sandhills information as the billing provider. (Originally posted 06/11/2013)

LME/MCO Provider Billing (Originally posted 06/11/2013)

ATTENTION MEDICAID PROVIDERS: Due to a system issue, Payment scheduled on 5/15/2013 has been rescheduled for 5/16/2013.  A notice will be sent to you as soon as payment is completed. - Remittance Advice information will be available to you after payment is completed. (Originally Posted 05/07/2013)

ATTENTION: Unmanaged Visits are now available for IPRS members (Originally Posted 05/07/2013)

DMH/DD/SAS announcements (Originally posted 04/26/2013)

Questions about NCTracks (Originally posted 04/26/2013)

April 2013 Medicaid Bulletin (Originally posted 04/22/2013)

April 2013 Medicaid Special Bulletin (Originally posted 04/22/2013)

DMH/DD/SAS announcements (Originally posted 04/22/2013)

DMH/DD/SAS announcements (Originally posted 04/12/2013)

ATTENTION: An Important Announcement to All Sandhills Center Guilford County Providers (Originally posted 03/05/2013)

An Important Announcement Regarding ProviderConnect... (04/03/2013)

New Announcements from DMH/DD/SAS... (04/03/2013)

An Important Announcement to Category A and B Providers regarding the Incident & Death Response System (04/03/2013)

Quarterly Provider Incident Reporting Form...

An Important Announcement to All Providers Regarding Direct Data Entry WebTool (03/06/2013)

An Important Announcement to All Providers from DMH/DD/SAS (03/06/2013)

Go to Archived Announcements prior March 01, 2013...

Memos

Date Posted

Link to Document (click on link below)

1/4/2013 Quarterly Incident Report Form
1/4/2013 Provider Letter Regarding Quarterly Incident Reports
12/30/2012 Important CPT Code Changes Effective 1/1/2013
12/21/2012 Important Billing Information
12/21/2012 DMH/DD/SA Announcements for 12-21-2012
12/13/2012 DMH/DD/SAS Announcements
12/5/2012 DMH Announcement
12/4/2012 December 2012 Medicaid Bulletin

The 1915 b/c Medicaid Waiver
P
ublic Educational Forums
Sandhills Center held widely publicized public forums starting in January 2012 and finishing in April 2012 in each of the eight counties that it serves. Below are materials used at each form and breakdowns of those that were in attendance:

 

 

 

 

 

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

Innovations Waiver


IPRS Provider Manual

FY 2012-2013

Medicaid Provider Manual

FY 2013-2014

Provider Memoranda

FY 2012-2013

FY 2011-2012

Clinical Practice Guidelines

Provider Forms

Finance/Claims

Provider Enrollment/Credentialing

Incident Reporting

Quarterly Provider Meetings

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