MEDICAID DIRECT PIHP CONTRACTS
SANDHILLS CENTER BH/IDD TAILORED PLAN CONTRACTS
Please remember that unless your current LME-MCO contract expires prior to September 30, 2023, all legacy LME-MCO current contracts are now for Medicaid Direct PIHP and automatically extended through the Tailored Plan launch.
INFORMATION FOR PROVIDERS
As of June 17, 2022, providers should no longer submit credentialing applications directly to Sandhills Center. Sandhills Center relies solely on the credentialing information sent over on the Provider Enrollment File through the North Carolina Department of Health and Human Services' (NCDHHS) centralized credentialing process.
The NCDHHS, through NCTracks, will continue to collect information and verify credentials for all providers currently enrolled or seeking to enroll in North Carolina’s Medicaid and/or Health Choice programs or as a State-Funded services provider. All changes to demographic information and clinician affiliations must be made directly in NCTracks in order for them to be reflected in our system
This change was made in accordance with the NCDHHS Division of Health Benefits contract Amendment #23, regarding provider credentialing.
Any change to a provider record including affiliating clinicians must be completed in NCTracks by filling out a Manage Change Request (MCR). Once the information is completed and approved in NCTracks, it will be ingested directly into our system.
PROVIDER ENROLLMENT/CONTRACTING INSTRUCTIONS
Sandhills Center maintains a closed behavioral health network for all our plans. However, we are open to all physical health providers for the Sandhills Center Tailored Plan. Physical health providers may contract directly with the Sandhills Center Tailored Plan by completing our Provider Join Form - PDF and Provider Contract Information Form - PDF.
Physical health providers currently contracted with our physical health subcontractor, AmeriHealth Caritas of North Carolina, may sign an amendment to their Standard Plan contract to participate in the Sandhills Center Tailored Plan as well.
The Sandhills Center Network Operations department would like to remind all physical health Tailored Plan provider partners of the following:
- Physical health care providers who have opted-in to the Sandhills Center Tailored Plan through AmeriHealth Caritas North Carolina are not automatically contracted to provide behavioral health/substance use disorder services for the Sandhills Center Tailored Plan.
- Any provider that is delivering a behavioral health service for a Sandhills Center member must be contracted directly with Sandhills Center for those services in order to bill and be reimbursed.
- Claims submitted for a behavioral health/substance use disorder service by a physical health care provider that is not contracted directly with Sandhills Center to provide those services may result in the denial of a claim.
- Sandhills Center operates a closed BH/SUD/IDD network and only services that are currently identified as a need will be eligible for consideration.
- The exception would be FQHCs who utilize a bundled code for all services. This bundled code is included in the physical health TP amendment.
- Providers who wish to contract with Sandhills Center in order to provide behavioral health services must submit the request via the Provider Join Form - PDF.
- For a comprehensive list of physical health service codes, please utilize the fee schedules available on the NCDHHS website.
A link to the NCDHHS Physical Health Covered Code has been included as an additional resource for providers. Note the codes listed are subject to ongoing updates.
Sandhills Center maintains a closed network for behavioral health services. Exceptions to join the network are considered on a case-by-case basis determined by current geographical and clinical areas of need. The following services are exceptions identified through our gaps analysis:
- Spanish-speaking prescribers
- Sex offender treatment specialists
- Credentialed professionals to develop behavioral health plans
- I/DD psychological testing
Providers interested in offering services are strongly advised to contact the Sandhills Center Network Operations department at ProviderJoin@SandhillsCenter.org to determine currently identified needs. If your request meets exception criteria, please complete the Request to Join Network Form - PDF and submit it to: ProviderJoin@SandhillsCenter.org. The Request to Join Network Form must be completed with all requests to be considered.
If you are currently enrolled as a Licensed Practitioner 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. To determine if your request meets the criteria for an exception, please send a letter of justification that 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). Please send justification, along with the Request to Join Network form - PDF, and submit to ProviderJoin@SandhillsCenter.org.
Confirmation of an active Provider Enrollment File is required per Sandhills Center policies/procedures regarding exception requests. If your request is approved, then the next step would be the execution of a contract.
Behavioral health providers who request to add a site and/or add services, please complete this form and submit to ProviderJoin@SandhillsCenter.org.
Upon a decision of the reviewed request, a notification of the decision will be emailed.
Remember: A Request to Join Network Form - PDF must be completed with all requests in order to be considered.
Have questions? Submit them to the Provider Help Desk