For Providers

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.
• April 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.

WELCOME TO THE SANDHILLS CENTER TAILORED PLAN AND NC MEDICAID DIRECT PROVIDER NETWORK

Sandhills Center is dedicated to helping you deliver services in accordance with state and federal standards.

Together, our goal is to provide quality care to our members and recipients, and their families, living in Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond, and Rockingham counties.

We are honored to have you join us in helping people with behavioral and physical health needs, traumatic brain injuries (TBI), and intellectual/developmental disabilities (I/DD) to get the whole-person care they need to improve the quality of their lives. 

The Sandhills Center Behavioral Health and I/DD Tailored Plan and NC Medicaid Direct Provider Manual - PDF offers information that supports efficient and effective management of NC Medicaid Direct and the NC Medicaid Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan. The provider manual will help you become familiar with the policies and procedures you are required to follow. Each contracted provider is responsible for adhering to all policies and procedures outlined in the manual. Compliance is necessary to fulfill contractual obligations. 

Sandhills Center maintains a closed behavioral health network while AmeriHealth Caritas of North Carolina, which handles physical health providers for the Sandhills Center Tailored Plan, maintains an open physical health network. 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 will result in the denial of a claim.
• Physical health care providers are restricted to billing for services where there is a primary medical diagnosis for the receiving member listed on the claim. In the event that a claim lists a primary behavioral health (BH) or substance use disorder (SUD) diagnosis for the member receiving the service, the claim will be denied.
• Sandhills Center operates a closed BH/SUD/IDD network and only services that are currently identified as a need will be eligible for consideration.
• Providers who wish to contract with Sandhills Center in order to provide behavioral health services must submit the request via the Provider Join Form. 
• For a comprehensive list of physical health service codes, please utilize the fee schedules available on the NCDHHS website.

The Physical Health Covered Code list has been included as an additional resource for providers. Note the codes listed are not all-inclusive and subject to ongoing updates. The guide does not ensure inclusion on a published NCDHHS fee schedule.

Need assistance? Visit the Provider Support Portal.

See our searchable directory: Sandhills Center Provider Directory

Provider Manual - PDF

Sandhills Center Quick Reference Guide for Providers - Download the Excel file

Still need help? Contact the Provider Help Desk:

• By phone - 1-855-777-4652
• By email - ProviderHelpDesk@SandhillsCenter.org