Single Case Agreements for Out-of-Network Providers
Single Case Agreements (SCA) are for out-of-network providers to request reimbursement for services they are seeking to provide to Sandhills Center Medicaid members.
The SCA is subject to medical necessity review and is for episodes of care that have not yet occurred.
A Provider Payment Agreement (PPA) request can be completed for retroactive urgent or crisis services that have been provided to Sandhills Center members.
Services should not be provided to Sandhills Center members prior to the establishment of an SCA and in-network options will need to be explored before an SCA can be granted. This does not apply to physical health services.
The following documentation must be included with your SCA submission:
- Physical and Behavioral Health Single Case Agreement (SCA) Application - PDF
- EFT Agreement - PDF
- Trading Partner Agreement - PDF
- SAR and other clinical documentation - PDF
- W9 - PDF
Please note that SCAs are no longer accepted via mail, fax, or email. If you have questions, please contact Sandhills Center through the Provider Support Portal or by calling the Provider Help Desk at 1-855-777-4652.
You can submit your SCA request by visiting the Provider Support Portal
- Select "New Support Ticket"
- Select Subject/Request Type “Request for Single Case Agreement (SCA)”
- Enter the necessary information and attach any required documentation
Have questions? Please call the Provider Help Desk at 1-855-777-4652, or submit a Provider Support Portal ticket.