Information for Providers of Services

ADA REQUIREMENTS REMINDER

Click for link  

NC MEDICAID WAIVER 2014 PROVIDER SATISFACTION SURVEY

LINK TO 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.

Rate Increase NEWS RELEASE

October 1 Rate Increase Detail

 

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 onnnur 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:

Documents Required:

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.

           

DSM-5 Update from Sandhills Center

May 15, 2014

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released in May 2013.  DHHS will implement DSM-5 coding requirements effective August 1, 2014.  The DSM-5 codes will be required for all dates of service beginning August 1, 2014.

The DSM-5 changes will be in place in the AlphaMCS system for August 1, 2014.  All NON-Complete codes in ICD9 will be end dated and only Complete Codes will be available.  Continue submitting SARs and Claims using Complete ICD9 codes as ICD10 has been extended until October 2015.

Sandhills Center recommends that providers begin preparing for this change by submitting Client Update Requests for members whose Diagnosis Code is not a Complete Code, begin using Complete Codes when requesting SAR’s and/or begin billing using Complete Codes.  If you bill using a Complete Diagnosis Code, the Diagnosis Code will be added to the members file and the claim should pay, assuming it meets all other criteria for payment.

Additionally, the ASAM Criteria:  Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, Third Edition was published at the end of 2013 and goes into effect on August 1, 2014.

Sandhills Center will not be offering additional provider training on DSM-5.  Please see our website for more information related to DSM-5 http://www.sandhillscenter.org/ click on For Providers and scroll towards the bottom.  There are many links for online training and other helpful information.

For questions, please contact the Sandhills Center Provider Help Desk at 1-855-777-4652 or via Email: ProviderHelpDesk@sandhillscenter.org .

Thank you.

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 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.

DSM-5, ASAM and ICD-10

DSM-5 Information

The DSM-5 (Diagostic and Statistical Manual of Mental Disorders) is the 2013 update to the American Psychiatric Association's classification and diagnostic tool.

Resources and Links DSM-5

Highlights of Changes from DSM-IV-TR to DSM-5

"From DSM-IV-TR to DSM-5 What Specifically is Changing?"
A workshop presented by
Sy Saeed, M.D., FACPsych,
Professor and Chairman
Department of Psychiatric Medicine
Brody School of Medicine--East Carolina University

 

Upcoming DSM-5 trainings:

 

http://www.ncpsychiatry.org/dsm-5-workshops

http://www.pesi.com/search/detail/index.asp?eventid=26441

http://www.pesi.com/search/detail/index.asp?eventid=26442

http://www.lpcanc.org/i4a/pages/index.cfm?pageID=3455

http://ncpsychology.com/wp-content/uploads/2014/04/2014-Cameron-Cooper-Flyer-FINAL.pdf

 

Online Training:

http://www.pesi.com/bookstore/Product.aspx?ProductCode=RNV047180         DVD

http://www.pesi.com/bookstore/Product.aspx?ProductCode=RNA047180         CD

 

 

Presentation about the DSM-5:

DSM-5 update part 1:    

http://www.youtube.com/watch?v=cWFRIAy2FGc&feature=youtu.be

 

DSM-5 update part 2:    

http://www.youtube.com/watch?v=QksM3beRUo8&feature=youtu.be

 

DSM-5 update part 3:    

http://www.youtube.com/watch?v=i1KXYlDUSpU&feature=youtu.be

 

The ASAM Criteria

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.

 ICD-10 Information

The deadline to comply with ICD-10 has been extended to October 1, 2015.

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 (06/01/2014-06/30/2014)

Help Desk Questions & Answers (05/01/2014-05/31/2014)

Help Desk Questions & Answers (04/01/2014-04/30/2014)

Help Desk Questions & Answers (03/01/14-03-31-14)

Help Desk Questions & Answers (02/01/14- 02/28/14)

Help Desk Questions & Answers (01/01/14- 01/31/14)

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

DELAY NOTICE:  RAs for this week's check write (July 29, 2014) will be delayed by one business day.

NEW Year End Closing Process Letter

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 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

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 FY2013-2014 

 

Medicaid ProviderManual 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