Claims Submissions/Billing

Posted 5/8/2023

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.

[Additional details for claims processing/billing will be available upon approval, including document links and other instructions]

The Sandhills Center Finance Claims department is responsible for the 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 Center staff in the Finance Claims department perform the following duties:

Issue payment and remittance advice (RAs) on paid and denied claims.
Assist the Sandhills Center 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 department is located at 1120 Seven Lakes Drive (P.O. Box 9), West End, NC 27376. The office is open from 8:30 a.m. to 5 p.m., Monday through Friday. For more information, call 910-673-9111.

RESOURCES

2023 Checkwrite Schedule - PDF

Medicaid Fee Schedule - PDF

State-Funded Fee Schedule - Download Excel File

Physical Health Out-of-Network Billing Claims Instructions - PDF

2022-2023 Tailored Plan Rate Sheet [link coming soon]

Health Insurance Information Notification Form [link coming soon]

Claims Inquiry Resolution Form [link coming soon]

ACH Direct Deposit Form [link coming soon]

837P Companion Guide [link coming soon]

837I Companion Guide [link coming soon]

835 Companion Guide [link coming soon]