Sandhills Center
For Immediate Help:
Main Menu
Provider Payment Agreement for Out-of-Network Medicaid Providers

Provider Payment Agreements (PPAs) are for out of network providers to request reimbursement for services provided to Sandhills Center Medicaid members. The PPA is subject to medical necessity review and is for retroactive episodes of care. For hospitals, the PPA is used for inpatient care only. Services provided in the emergency department of a hospital do not require a PPA but should be billed directly.

 Trading Partner Agreement

Timely Filing Letter and Guidelines — updated 4/1/2017

W-9 Form – updated 11/2017

Service Authorization Request (SAR)

PPA Checklist

PPA Application