Reimbursement

The Finance Claims division is responsible for daily monitoring of provider claims. Claims Specialists review denial data and work with internal staff and providers to correct errors causing claims to be denied. The division also monitors retroactive Medicaid eligibility and recovery of funds. Sandhills staff in Finance Claims perform the following duties:

• Issue payment and remittance advices (RAs) on paid and denied claims.
• Assist the Quality Management Department with claims quality audit processes.
• Recover funds based on audit findings.
• Audit providers for coordination of benefits.
• Report all credible allegations of Fraud and Abuse to Program Integrity.

The Finance Claims division is located at 1120 Seven Lakes Drive, West End, NC 27376. The office is open from 8:30 a.m. to 5 p.m., Monday through Friday. For more information, please call (910) 673-9111.