Information for Providers of Services
Sandhills Center is currently testing ICD-10 with our vendor. All providers and clearing houses interested in ICD-10 format testing with Sandhills are invited to contact us at email@example.com.
· Sandhills has relaxed the original end date of July 31st for ICD-10 testing. We will accept test 837s through August 31st.
· Limit test files to a maximum of 10 claims, multiple test files will be accepted.
· Providers who submit 837I and 837P files should send both for testing.
· Test files will be processed within 5 business days. Notification will be sent upon test completion.
· Sandhills has experienced issues with our FTP notifications; we are requesting test files submitted via secure email to firstname.lastname@example.org. If you are unable to send secure email, notify us and we will send you a secure email which you can reply and submit your test file(s).
Email questions to email@example.com
ATTENTION: HCBS Provider Self Assessment LME- MCO/LLA/Provider Statewide Training Attendees
Click here to print out the statewide training document for July 22
Click here to print out the Assessment Q&A for July 24th
Please be advised that the link for the e assessment has changed. The new link is: http://www2.ncdhhs.gov/hcbs/assessment.html
B3 NC NON-INNOVATIONS WAIVER SERVICES
The Sandhills Center is seeking existing credentialed 1915(c) waiver providers in good standing interested in B3 funding for NC Non-Innovations Waiver Services. These bundled services are for individuals with Medicaid, who are functionally eligible for an Innovations waiver slot but do not have Innovations waiver funding. In addition, children and adults must be moving from an ICF/MR to a setting within the community. Children ages 3-21 must not be living in a child RTF.
Funding is limited to five (5) individuals with an individual budget up to $135,000. Please note that B3 services are not an entitlement and eligibility and services are limited to the amount of capitated B3 funding available. Providers will only be awarded funding if selected by the member for services approved in the ISP.
Providers must already be credentialed with Sandhills Center for the Innovations service(s) and meet all NC Innovations waiver provider requirements. This is not an opportunity to add Innovations services or sites
If you meet the above requirements and wish to be considered to provide a service, you do not need to do anything. If you do not desire to participate, please email Brenda Woods at firstname.lastname@example.org no later than August 4, 2015. Please include in your response: “Agency Name declines to participate in B3 NC Non-Innovations Waiver Services.”
B3 Innovations Services Codes
Assistive Technology Equipment and Supplies T2029 U4
Behavioral Consult T2025 HO U4
Community Guide – Monthly T2041 U4
Community Guide – Periodic T2041 U1 U4
Community Networking – Group H2015 HQ U4
Community Networking – Individual H2015 U4
Community Networking – Class and Conference H2015 U1 U4
Community Networking – Transportation H2015 U2 U4
Community Transition T2038 U4
Crisis Services – Primary Response H2011 U4
Crisis Services – Out of Home T2034 U4
Day Supports – Group T2021 HQ U4
Day Supports – Individual T2021 U4
Developmental Day T2027 U4
Home Modifications S5165 U4
In-Home Intensive Supports T1015 TD U4
In-Home Skill Building – Individual T2013 U4
In-Home Skill Building – Group T2013 HQ U4
Natural Supports Education – Individual S5110 U4
Natural Supports education – Conference S5111 U4
Personal Care Services S5125 U4
Residential Support Level 1 H2016 U4
Residential Support Level 2 T2014 U4
Residential Support Level 3 T2020 U4
Residential Support Level 4 H2016 HI U4
Respite – Individual S5150 U4
Respite – Group S5150 HQ U4
Respite – Facility S5150 US U4
Respite – Nursing LPN T1005 TE U4
Respite – Nursing RN T1005 TD U4
Specialized Consultative Services T2025 U4
Specialized Consultative Services – BCBA T2025 HO U4
Supported Employment – Group H2025 HQ U4
Supported Employment – Individual H2025 U4
Provider Network Operations Department
For Immediate Release June 25, 2015
West End, NC – June 25, 2015 – Sandhills Center, the organization responsible for public mental health, intellectual/developmental disability and substance abuse services in Anson, Guilford, Hoke, Harnett, Lee, Moore, Montgomery, Randolph and Richmond counties, announced today that it is increasing the reimbursement rate to providers of the medical service, Evaluation and Management (E/M) Coding by 13 percent. The new reimbursement rate for this billing process will increase on July 1, 2015.
E & M codes allow psychiatrists, non psychiatric physicians, physician assistants, and nurse practitioners the ability to effectively plan and monitor integrated treatment around clinical history, examination, and medical decision making. It allows individuals to receive treatment based on their individual history with an assessment and clinical care plan based on their individualized needs. It allows the provider the opportunity to be reimbursed for the care provided – both in the amount of time counseling the member and in the amount of time coordinating care for the member.
This coordination of care is equally important as it supports the expectation that licensed clinicians and contracted providers work within an integrated physical and behavioral health framework that is accountable for achieving objective and sustained improvements in patients’ outcomes including various quality indicators of behavioral and physical health.
By increasing the E&M code rates, Sandhills Center is supporting licensed clinicians and providers in this integration of care work and is continuing its commitment to ensuring members receive the highest quality, medically necessary care available by contracted providers with the expertise to meet the individual’s clinical need. The July 1, 2015 rate increase follows earlier rate increases for Outpatient services, Assertive Community Treatment Team services and Multi-Systemic Therapy that were effective October 1, 2014.
“One of the benefits of Sandhills Center becoming a 1915 (b)/(c) waiver site for managing services was that we could reinvest savings back into our local communities. Today, we have the opportunity to do that. We are pleased to increase the E/M Coding rate to assist our provider network to offer high quality services to our members”, said Victoria Whitt, Chief Executive Officer for Sandhills Center.
CONTACT: Liz Switzer, Community Relations and Communications , 201 N. Eugene Street, Suite A, Greensboro, NC 27401, 336.389.6200, email@example.com
YEAR END CLOSING PROCESS
2015 PROVIDER CAPACITY, COMMUNITY NEEDS ASSESSMENT AND GAPS ANALYSIS REPORT
INCIDENT WAIVER REPORT
ADA REQUIREMENTS REMINDER
NC MEDICAID WAIVER 2014 PROVIDER SATISFACTION SURVEY
SANDHILLS CENTER ANNOUNCES SERVICE RATE INCREASE
Sandhills Center is increasing reimbursement rates for several community-based services. Reimbursement for community Outpatient services and for the evidence-based services of Assertive Community Treatment (ACT) Team and Multi-Systemic Therapy (MST) will increase on October 1, 2014. For details, please click on the following links.
2014 PROVIDER CAPACITY COMMUNITY NEEDS AND GAP ANALYSIS REPORT (To access the report, click here.)
SEPTEMBER 29, 2014 LISTENING SESSION FOR NC IDD SERVICES WITH DAVE RICHARD (Click here for details.)
Effective July 1, 2014
Revised Process for ICF/MR LOC Utilization Review Requests
An ICF/MR LOC electronic form is located on our website at www.sandhillscenter.org.
Every 180 days, following each facility’s typical Utilization review cycle, the facility is required to complete Level of Care Eligibility Determination tool for each resident.
The Sandhills Center ICF/MR LOC electronic form has to be completed in its entirety for Utilization Review(and Medical Evaluation form if applicable).The form may be signed by the facility’s physician at the time of the scheduled Utilization Review. The form is good for 30 days from the date the physician signs/dates the form and checks the member continues to meet ICF/MR LOC. The member’s utilization review reauthorization must start within 30 days of the date of the physician’s signature.
The provider must submit a Service Authorization Request(SAR) in the Alpha system for the utilization review period for each member. The provider must attach the LOC form(and medical evaluation if applicable) to the SAR in the Alpha system.
The CM/UM Care Manager will review the SAR and the information from the assessments and verifies that the documentation supports the eligibility criteria documented on the Sandhills Center ICF/MR Level of Care Eligibility Determination Tool.
If the documentation continues to support ICF/MR eligibility criteria, The CM/UM Care Manager will print the LOC from the SAR and sign it to approve continued ICF/MR reauthorization. The SAR will be approved in the Alpha system.
The CM/UM department will make a pink copy of the approved LOC and mail to the provider. The CM/UM department will also make a blue copy of the approved LOC and mail to DSS.
*When utilization review is completed by the provider, the ICF/MR Utilization Request Form(can be downloaded from our website) still has to be completed in its entirety and mailed asap to:
Sandhills Center, Attn: CM/UM Department , ,
,P.O. Box 9
,West End, NC 27376
Initial LOC Determinations:
Completed/updated IQ and adaptive skills evaluation(Intellectual Disabilities)
Completed/updated Medical assessment-if applicable(Medical conditions)
Completed MCO Level of Care Eligibility Determination Tool(LOC)
Completed ICF/MR Utilization Review Request form
*How current does the psychological evaluation need to be? For an initial request, 3 years for persons 18 and older or within one year for children less than 18.
All required documents are mailed to Sandhills Center MCO, Attn: CM/UM department
Upon receipt, the CM/UM Care Manager reviews the information from the assessment/evaluation and verifies that the documentation supports the eligibility criteria that are documented on the LOC. If eligibility is verified, the CM/UM Care Manager builds a Service Authorization Request(SAR) in Alpha for the ICF/MR residential service. A blue copy of the approval is mailed to DSS and a pink copy is mailed to the receiving facility.If the assessment/evaluations do not support that the person meets ICF/MR Level of Care criteria, Sandhills Center MCO Medical Director will review the information and make the final determination.
LOC Form Sandhills Center
Important Diagnostic Data Entry Reminders
July 9, 2014
Sandhills Center Provider:
Below are a few AlphaMCS reminders related to Diagnosis entry and the upcoming DSM 5 implementation.
When identifying a diagnosis during Client Enrollment or Update, please make sure that the diagnosis code you select matches the verbiage for the Diagnosis the Client will be treated for, and is a complete code. For example Diagnostic code 296.90, could mean “Unspecified Affective Psychosis” – or – “Mood Disorder NOS”. If you are not clear which diagnosis you select and enter an alternate description than what has been selected in the AlphaMCS system as part of the SAR there could be a discrepancy during the Utilization Management review and cause a delay.
When performing a Client Update, after you as the provider have confirmed that the member is enrolled, make sure to view the diagnosis(es) that are currently in the AlphaMCS system for that member. If any of the diagnosis(es) that you will be treating the member for are not in the system, be sure to add them using the Client Update feature.
Please remember to select an AXIS and a Class for your diagnoses. If your diagnosis is the initial diagnosis also please remember that the Principal and Primary Diagnosis (B diagnosis) is the reason for admission and will remain the member’s principal and primary diagnosis for the entire admission.
As previously announced by DHHS (Communication Bulletin #142), the number of Benefit Plans is being reduced from 35 to 10 effective August 1, 2014. If a member you are serving is in a Benefit Plan to be discountinued, use the Benefit Plan Crosswalk provided by DHHS to identify the member’s new Benefit Plan. The member’s new Benefit Plan information should then be submitted using the Client Update feature within AlphaMCS.
As a reminder, DSM 5 codes will be required for all dates of service beginning August 1, 2014. Please make sure to begin using complete DSM 5 codes when requesting SAR’s and submitting your billing.
Please contact Carol Brown, ME&E Lead Intake Specialist at 910-673-7325 with questions.
Sandhills Center is approaching our fiscal year end for 2013-2014. Providers who bill for State services, please make sure all of your services are being billed weekly.
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.
March 31, 2014
Sandhills Center has transitioned to our new software
AlphaMCS Provider Portal.
"From DSM-IV-TR to DSM-5 What Specifically is Changing?"
Upcoming DSM-5 trainings:
Presentation about the DSM-5:
DSM-5 update part 1:
DSM-5 update part 2:
DSM-5 update part 3:
The ASAM Criteria: Treatment Criteria for Addictive, Substance –Related, and Co-Occurring Conditions, Third Edition was published in October 2013. According to the American Society of Addiction Medicine, the new manual is a user-friendly guide to understanding the core principles, processes and procedures in the ASAM criteria. This new manual is also compatible with the DSM-5. All clinical policies, rules, protocols, etc. are updated in this new manual.
The implementation date for The ASAM Criteria Third Edition will be August 1, 2014. The use of ASAM is required for both the Division of Mental Health Developmental Disabilities and Substance Abuse Services and the Division of Medical Assistance in the determination of levels of care for substance abuse services.
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
Help Desk Questions & Answers (12/01/13 -
PowerPoints from Provider Orientation
The PowerPoints below were used during the March 14, 2013, and March 26, 2013, Sandhills Center Provider Orientation.
ICD-10 Implementation Update
CMS Webinar on Clinical Documentation Improvement for ICD-10 on December 10
The Centers for Medicare & Medicaid Services (CMS), in association with the American Health Information Management Association (AHIMA), is hosting a Webinar on "Clinical Documentation Improvement to Support ICD-10 Readiness" on Wednesday, December 10, from 12:00 p.m. to 1:30 p.m. ET. The webinar will address why detailed clinical documentation is important for the ICD-10 transition, steps for training your staff, and additional resources and information. An opportunity for Q&A will also be provided.
Space is limited. To register, click on the link below. Once your
registration is complete, you will receive a follow-up email with
step-by-step instructions on how to log-in to the webinar.
NEW NC TOPPS 2014-15 User Guide and Tools #143 http://www.ncdhhs.gov/mhddsas/communicationbulletins/index.htm
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