Sandhills Center
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Emergency Department Claims from Out-of-Network Hospitals

Claims from out-of-network hospitals for services provided in the emergency department to Sandhills Center Medicaid members can be billed directly. Hospitals will need to complete an ED Reimbursement Request Form, a Trading Partner Agreement and a copy of their W-9.

Emergency Department Cover Letter

Emergency Department Reimbursement Request Form

Trading Partner Agreement

W-9 Form

Please submit the forms by email, fax or mail.

Email Address:          karend@sandhillscenter.org

Fax Number:             (910) 673-0904

Mailing Address:      Sandhills Center

Attn: Karen Nall Dunn, Network Management

P.O. Box 9

West End, NC 27376

Once your reimbursement request form (application) has been reviewed, you will be enrolled as a provider of Emergency Department services and will be eligible for billing options as outlined on the form. For inquiries regarding this reimbursement/application process or status, please contact Karen Nall Dunn at (910) 673-7515 or via email at karend@sandhillscenter.org.