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.
(Adult Mental Health/Child Mental Health)
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.
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.
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.
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.
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.
Primary Care Provider no longer requires assistance with the individual’s psychiatric needs.
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.
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.
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:
March 31, 2014
Sandhills Center has transitioned to our new software
AlphaMCS Provider Portal.
All Providers are accepting new members
Letters from Victoria Whitt
Important announcement from Anthony Ward,
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
PowerPoints from Provider Orientation
The PowerPoints below were used during the March 14, 2013, and March 26, 2013, Sandhills Center Provider Orientation.
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 firstname.lastname@example.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.
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)
New Announcements from DMH/DD/SAS... (04/03/2013)
The 1915 b/c Medicaid
A Local Management Entity - Managed Care Organization
Victoria Whitt- Chief Executive Officer
Sandhills Center Resources
Medicaid Provider Manual
Quarterly Provider Meetings