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Provider Enrollment/Credentialing

Provider Enrollment/Credentialing

About the Sandhills Center Network

Sandhills Center is a North Carolina Medicaid 1915 (b/c) waiver site, which establishes our network as a single Prepaid Inpatient Health Plan (PIHP) through which mental health, substance abuse and intellectual/developmental disabilities services (I/DD) will be authorized and paid.

Sandhills Center handles authorizations and payments to providers for all appropriately-delivered Medicaid services for Medicaid enrollees in the nine counties we serve.

Provider Enrollment/Credentialing Instructions

Sandhills Center is a closed network. Exceptions to join the network are considered on a case by case basis determined by current geographical and clinical area of needs.  Interested providers are strongly advised to contact Network Operations at ProviderJoin@SandhillsCenter.org to determine Sandhills Center’s current identified needs.

Current Providers

If you are currently credentialed as a Licensed Independent Provider under an agency or hospital in the Sandhills Center Network, and want to become a solo LIP, or if you are a solo LIP that wants to apply as an agency, please send a “Change of Business Model request” e-mail to ProviderJoin@SandhillsCenter.org. In order to determine if your request meets the criteria for an exception, please send a letter of justification which demonstrates the value that this change would bring to the Sandhills Center network. Requests should include a list of specialty areas of practice you are rostered and certified for, years of experience, and number of Sandhills Center Medicaid members you currently serve, or estimate you will serve, and current referral sources. Please include a copy of your resume (and in the case of an agency request, all resumes for providers who will practice with you).

Submitted documentation will be reviewed per Sandhills Center policies/procedures regarding exception requests.  If approved, then the next step would be for you to submit a credentialing application.  

Requests will be reviewed, and notification of a decision will be emailed.  Please note that an approval to proceed with the credentialing process does not guarantee admission to the network.  Network admission is contingent on completion of the credentialing process.

Questions? Submit Provider Enrollment Questions Here


Credentialing & Recredentialing Criteria

Provider Credentialing and Recredentialing (Medicaid and IPRS) document

Agency/Facility

An Agency/Facility is a legal entity that is registered with the Secretary of State or local municipality and has a tax identification number. To enroll as an agency/facility, you must select, complete, and submit the appropriate application.

All individuals with 5 percent or greater direct or indirect ownership interest in the agency/facility must sign and submit the State Bureau of Investigation form directly to Sandhills Center with application submission. Do not submit to the SBI.

NOTE: If your agency/facility delivers outpatient services, each practitioner must also submit an application to be credentialed (as a Licensed Practitioner). Please coordinate with your licensed practitioners regarding timely application submission.

All applications must be signed and dated originals.

Licensed Practitioners

A Licensed Individual Practitioner is a professional who is directly enrolled with and directly bills to Medicaid for services rendered.

All Licensed Individual Practitioners are required to be credentialed and will need to complete and submit the Uniform Application to Participate as a Healthcare Practitioner Application. If you work for an agency/facility and do not have a solo practice, please coordinate application submission with your employer.

NOTE: Licensed Practitioners applying for network enrollment should sign and submit the “Authority for Release of Information” (State Bureau of Investigation form) directly to Sandhills Center with application submission. ONLY Licensed Practitioners that have a “solo practice” or are part of a “group practice” need to submit this document. Agencies are responsible to complete background checks for Licensed Practitioners they employ.

You may be enrolled with the Council for Affordable Quality Healthcare (CAQH). This data source will suffice for some of your credentialing and recredentialing requirements. If you are a participating provider with CAQH and authorize Sandhills Center to access your information, please let us know. We will retrieve your information for review and contact you for any additional information. You may register with CAQH at no cost by visiting: CAQH.org.

Addendum to CAQH NC Uniform LIP Credentialing-ReCredentialing Application

For IPRS (State Funded) Network Providers

Sandhills Center currently is not expanding IPRS contracts at this time.

However, if you are an existing Sandhills Center IPRS network provider, you may complete the Agency Credentialing Application to continue delivering IPRS-funded services.

If you are a Sandhills Center Network provider that delivers service(s) that are only IPRS Reimbursable (Group Living, Supervised Living, ADVP, etc.), but do not deliver a Medicaid service, you must complete and submit the Agency Credentialing Application linked in the above paragraph to continue the credentialing process.