These are the latest announcements, news items, and resource links from the Network Operations department. This page is intended specifically for providers within the Sandhills Center network and will change occasionally, based on the most current information available.
If you have questions, please contact the Provider Help Desk, or refer to the Provider Support Portal.
On Wednesday, November 8, 2023, from 9 a.m. to Noon, in collaboration with all of the other prospective Tailored Plans in the state, Sandhills Center is cohosting a program highlighting the eight recognized tribes in North Carolina. There is a link to register included in the flyer, below. Please feel free to share this information.
On April 1, 2023, Sandhills Center migrated its UM software system from Alpha+ to Jiva. Service Authorization Requests (SARs) require a billing site be attached to the request, and this site must match the provider’s contract details in order for claims to be paid. In other words, the billing site listed on the SAR must be contracted for the particular service code being requested.
Alpha+ required the provider to enter the billing site correctly in order for the SAR to be submitted. If the site was incorrect, the SAR could not be submitted. As part of the transition to Jiva, providers have been able to submit SARs even if the billing site is incorrect. When this occurs, Sandhills Center UM staff receive a “soft stop” that warns them the provider site on the SAR is incorrect. This has allowed Sandhills Center to gather information to ensure all provider sites were correctly loaded into Jiva and to provide technical assistance to providers on how to correctly identify the billing site.
As of Sunday, October 22nd, providers are no longer be able to submit a SAR if the billing site attached to the SAR does not match the provider’s contract details. The provider will receive a “hard stop” informing them the SAR cannot be submitted. The SAR can be submitted when the billing provider information is correct. If you receive a hard stop and need help identifying the correct billing site, please submit a ticket to the Provider Support Portal. During this time of transition, The Sandhills Center UM department will work with providers if SARs are submitted late due to the hard stop. To guarantee your SARs will be accepted late (i.e. after the start date listed on the SAR), please reach out to your individual Sandhills Center UM reviewer or UM Director Sarah Glanville so we can work with you on late SAR submissions.
Providers who offer services that require utilization of a Person-Centered Plan (PCP) will be required to comply with the new guidance outlined in the Person-Centered Planning Guidance Document as of Wednesday, November 1, 2023.
The Guidance Document references that all who develop plans must attend a state-approved training.
To access the training on Behavioral Health Springboard's website, visit https://bhs.unc.edu under online trainings. Click on the title, "From Theory to Practice: Person-Centered Planning in NC." You will then be directed to create an account to enter the website.
Sandhills Center will provide additional information and answer questions at the upcoming Provider Forum on Wednesday, November 8, 2023, from 9 a.m. to Noon.
FOR OPIOID TREATMENT PROVIDERS
The North Carolina Department of Health and Human Services (NCDHHS) has issued a temporary licensure waiver for Opioid Treatment Programs to provide increased flexibility and promote more successful practices. The Division of Health Service Regulation (DHSR) will send information, including the Waiver Request Form, to program contacts. In addition to DHSR’s form, providers who wish to take advantage of this waiver must contact each Local Management Entity-Managed Care Organization they contract with to request a Letter of Support. To request a Letter of Support from Sandhills Center, please send an email to OTPRequest@SandhillsCenter.org, including your program’s information (Program name, site address, and name of the Point of Contact) and Diversion Plan. For additional information, see the NCDHHS Overview of 2023 Temporary Waiver presentation.
NCDHHS has notified Sandhills Center that all current local modifiers are under DHB and DMH review and a decision on continued utilization will be made. They have requested that we continue to utilize our local modifiers until further notice, therefore, they will not be sunsetted on September 30, 2023, as initially announced. We will notify our provider network once we are given a definitive date.
Per the NCDHHS, Sandhills Center will stop utilizing this list of local modifier codes - PDF as of September 30th, 2023. We are working on alternatives to these modifiers and will update you all once we have those in place.” For convenience, NC Medicaid also offers a list of “Active Provider Re-Verification Due – July 2023 – Dec 2023” dates (updated biannually). The reverification due date displayed is also the health plan suspension date of the provider record if no action is taken to submit the reverification application under the applicable NPI. If the health plan is suspended, claims payment will stop.
Providers are encouraged to review the reverification due date list, and frequently check their Provider Message Inbox for notifications or the reverification section of the Status and Management page in the NCTracks Secure Portal for the option to reverify. In addition to the resources below, providers may contact the NCTracks Call Center at 800-688-6696 for assistance.
Payment Suspension at Re-Credentialing
As a reminder, Plans are required to suspend claims payment to any provider for Dates of Services after the effective date provided by the Department in its network within one (1) business day of receipt of a notice from the Department that Provider payment has been suspended for failing to submit re-credentialing documentation to the Department or otherwise fail to meet Department requirements.
- Provider Reverification/Recredentialing webpage: Also contains a link to the re-verification due date list referenced above
- Re-verification/Recredentialing FAQs
- User Guide: How to Complete Re-verification in NCTracks
- NC Medicaid Provider webpage: Access to Medicaid Bulletin articles and Provider Enrollment information
COVID-19 Flexibilities to End
Effective May 11, 2023, the clinical policy flexibilities that were instituted as part of the federal Public Health Emergency will end. This includes flexibilities for authorizations, staffing ratios, sites of service, training requirements and others. For more information, please see Special Bulleting #265.
Please note that this does not apply to Innovations Appendix K flexibilities. Appendix K flexibilities will end Nov. 11, 2023.
Claims Timeline Changes
On May 3, 2023, the State made the following changes to the Claims Filing Timeline for all the TP/PIHPs. This change supersedes Sandhills Center's April 1, 2023 announcement. The timely filing timeframe will be extended from 180 days to 365 days. The earliest effective date of this change will be July 1, 2023. The timely filing change will be required for all claims with service dates on and after July 1, 2023. This change directly impacts all Claims and Retroactive Enrollees' timely filing rules.
Sandhills Center LME-MCO/Medicaid Direct PIHP Contracts
Please remember that unless your current LME-MCO contract expires prior to September 30, 2023, all Current LME-MCO Contracts are automatically extended through September 30, 2023, or until the Tailored Plan launch, whichever is later. Providers whose contracts expire prior to September 30, 2023, will receive extension documents. If your contract expires prior to the Tailored Plan Launch or September 30, 2023, and you have not already received an extension through Docusign by June 15, 2023, please contact Michael LaDisa.
Sandhills Center to host Jiva refresher course on March 31
In preparation for the Jiva launch on April 1, 2023, Sandhills Center's Utilization Management Department will host a Jiva refresher course on Friday, March 31st from 10 a.m. to 12:30 p.m.
This will mimic the prior training that was offered on Feb. 17, Feb. 24, and March 9. The March 31 session will offer providers who have not yet been trained in Jiva a chance to learn the system while also giving already-trained providers the opportunity for a refresher.
The link for the March 31 training was sent to all who attended one of the other Jiva provider portal training sessions through the Sandhills Center provider listserv. There is no need to register. Simply click on the link in your email to attend. If you did not receive the link, please email Sarah Glanville, UM Director.
Note: Any requests for the link sent after 9 a.m. on Friday, March 31, may not be received prior to the training so be sure to send your request before then.
Jiva System to launch April 1, 2023, for all SAR Submissions
This is a reminder that Sandhills Center will be launching authorizations in Jiva on April 1, 2023. On March 22, 2023, all providers were sent a step-by-step guide for how to submit authorizations in Jiva for those who were unable to attend the training sessions provided on 2/17/2023, 2/24/2023, and 3/9/2023. We are also announcing a positive change in our authorization process, as the previous need to split authorizations between Alpha and Jiva will no longer be needed. Authorization requests will no longer be submitted in Alpha+ beginning 4/1/2023. At that time, all authorization requests -- regardless of date -- should be submitted through Jiva. Jiva is accessed by signing into Alpha+ and then clicking the green Jiva button at the top of the screen. Please submit an IT Ticket through the Provider Support Portal if you require any assistance. You may also contact the Provider Help Desk by phone at 1-855-777-4652, or send an email to ProviderHelpDesk@SandhillsCenter.org
Posted March 2023
No Jiva authorization implementation on 3/1/2023
The Sandhills Center UM Department would like to inform providers that the implementation of the Jiva authorization system has been delayed from 3/1/2023. This is due to changes NC Medicaid has made related to the delay in the Tailored Plan launch. Sandhills Center hopes to implement Jiva in the coming weeks but for now, providers should not enter any service authorization requests (SARs) in Jiva.
Because we still hope to implement the Jiva authorization system soon, we will still hold our third scheduled Jiva Provider Portal Training on Thursday, March 9th from 3 to 5 p.m. We also will offer a refresher session the week before Jiva goes live. More information about the refresher session will be shared once it has been scheduled.
Note: This announcement is unrelated to the switch in claims software to Change Healthcare that was discussed at the Provider Forum held on 2/22/2023. More information will be forthcoming from the Sandhills Center Finance Department regarding when that software will be implemented.
Please share this information with anyone in your organization who submits SARs. If you have any questions, please feel free to contact Sarah Glanville, UM Director.
IMPORTANT ANNOUNCEMENT FOR PROVIDERS
Sandhills Center's Utilization Management department will hold three upcoming training sessions for providers to learn the new Jiva authorization system.
Sandhills Center will be moving its authorization software from Alpha+ to Jiva.
These training sessions will give providers an opportunity to see the system and learn how to enter Service Authorization Requests (SARs) through Jiva. This change applies to ALL Sandhills Center providers and all benefit plans. The change to Jiva applies to any authorization dates after 3/31/2023.
The training dates and times are:
- Friday, February 17, 2023 - 10 a.m. to Noon
- Friday, February 24, 2023 - 10 a.m. to noon
- Thursday, March 9, 2023 - 3 to 5 p.m.
Microsoft Teams links for each training were sent to you or your facility via email. You do NOT need to register for this training. It is recommended that all staff who enter authorizations for your business attend one of the training sessions. Please forward the email you received to all relevant staff so they will have the Teams links. All training sessions are the same – you only need to attend one.
Sandhills Center UM will assess whether additional training sessions are necessary and add dates as appropriate.
Training guides will be distributed via the Teams chat during the training.
Please direct any questions to Sarah Glanville, Sandhills Center UM Director.
Announcement date 11/28/2022
In alignment with the new Tailored Plan launch date of April 1, 2023, this bulletin extends the termination date for related services and the grandfathering transition process from Nov. 30, 2022, to March 31, 2023.
In the event that those individuals enrolled in the above residential services for IDD & TBI on Jan. 31, 2023, who do not meet the service criteria for Residential Supports (I/DD & TBI) on the basis of age and/or the individual’s SNAP/SIS score, providers must submit an encrypted Grandfather Request Form for those impacted. This form must be completed and returned to DeVicka Cheston Santana no later than Feb. 15, 2023.
If you have any questions, please contact Stephanie Jones at 984-236-5043, or send an email message to: DMHIDDCONTACT@dhhs.nc.gov.
TAILORED PLAN AND NC MEDICAID DIRECT
Contracting Documents for Tailored Plan and NC Medicaid Direct providers
- NNM 24 Good Faith Contracting Policy
- NNM 24a Good Faith Contracting Procedure
- Sample Tailored Plan Hospital Contract
- Sample Tailored Plan Agency Contract
- Sample Tailored Plan LIP Contract
- Sample Tailored Plan AMH+/CMA Contract
- Sample NC Medicaid Direct Hospital Contract
- Sample NC Medicaid Direct Agency Contract
- Sample NC Medicaid Direct LIP Contract
Notice on Provider Updates – Third-Party Agents/Vendors
Sandhills Center is committed to keeping our provider network up to date on the latest topics so that our network has the tools to care for our members. As it is considered standard operational activities of a provider to ensure they update and maintain all pertinent information, it is the responsibility of each provider to ensure this information is received and disseminated to their third-party agents/vendors.
Therefore, requests to include a provider’s third-party agent/vendors on the Provider Update email list will not be accepted.
Remember to update Sandhills Center whenever an email contact needs to be removed or whenever adding a new contact.