For Providers

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 Jun 15, 2023, please contact Michael LaDisa.

Jiva System to launch 4/1/2023 for all SAR Submissions

This is a reminder that Sandhills Center will be launching authorizations in Jiva on 4/1/2023. 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

For more information, visit the Provider Portal Training Guide - PDF

WHAT KEY TAILORED PLAN DATES DO PROVIDERS NEED TO KNOW?

• Jan. 5, 2023 – Last day for providers to have fully executed contracts with Tailored Plans for inclusion on the first day of the beneficiary choice period.
• Jan. 15, 2023 – Tailored Plan auto-enrollment and Beneficiary Choice Period begin. Beneficiaries can choose a PCP by contacting their Tailored Plan.
• Jan. 15, 2023 – Last day for Primary Care Providers (PCPs) to have fully executed contracts with Tailored Plans for inclusion in PCP auto-assignment.
• Jan. 23, 2023 – The Enrollment Broker begins mailing Tailored Plan Enrollment Packets to beneficiaries.
• Feb. 14, 2023 – Last day for beneficiaries to choose a PCP before auto-assignment.
• Post-Feb. 15, 2023 – PCP auto-assignment for beneficiaries who have not chosen a PCP.
• Oct. 1, 2023 – Official launch date for the NC Medicaid Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans.

NC Medicaid Managed Care has published the Contracting with Tailored Plans fact sheet. The fact sheet contains, among other things, key dates providers need to know, including the Jan. 5 and Jan. 15 contracting deadlines for PCPs. For more information on Provider and Tailored Plan Contract Deadlines for Inclusion in Beneficiary Choice Period and Auto-Assignment, please review the bulletin using the link. Please see the fact sheet and bulletin for important information, dates, and contact information.

ABOUT THE SANDHILLS CENTER PROVIDER NETWORK

Sandhills Center's Provider Network is dedicated to offering quality care for individuals residing in Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond and Rockingham counties. Our provider network assists Sandhills Center in fulfilling our mission to develop, manage and assure that persons in need have access to quality mental health, developmental disabilities and substance use services.

Each contracted provider is responsible for adhering to all policies and procedures outlined in the Provider Manual. Compliance is necessary to fulfill contractual obligations in providing services.

Find the searchable directory: Sandhills Center Provider Directory

Please note: Links to important provider topics are located under "In this Section" on the left of your screen (for PC users). If you are using a mobile device or tablet, "In this Section" is located toward the top of your screen. The menu topics appear in alphabetical order for ease of use.