TYPE OF CALL QUESTION ANSWER. from the CAQH database for the application process?

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1 Can Sandhills Center pull information from the CAQH database for the application process? This is a brand new credentialing application process, the entire application must be completed. Are there any other exemptions from the Provider Corporate/Endorsement Credentialing and Service being that we are already CARF accredited? Can you provide services to a Harnett Co. member in Cumberland Co.? Does a therapist have to be credentialed by Medicaid and Sandhills Center? Will you be able to verify Medicaid eligibility through Sandhills Center? Will Sandhills Center do all the authorizations and billing? Does Sandhills Center refer members to Providers? Do I fill out an application for IPRS if I already have a contract? Do we only complete the IPRS application if we do not bill Medicaid services through Sandhills Center? Does our psychiatrist; who is employed full time at our agency, need to enroll separately? If you deliver a service(s) that require "Core Rules" and are an existing provider you will not have to submit the policy and procedure manual nor will you have to submit the self study of core rules. As of 3/26/12, there are no exemptions from the Provider Corporate/Endorsement application based on any accreditation. Yes, the member can be served in Cumberland Co. The therapist must be credentialed by Sandhills Center and have a contract or be employed by an agency that has a contract with Sandhills Center. Medicaid can be verified online or by calling Sandhills Center does not refer to a particular provider however if a member calls and needs services, the Calcium Calendar is utilized to link a member for an assessment. Yes if you are a current IPRS provider and want to continue delivering an IPRS service beginning July 1, 2012, an application has to be submitted. The application is what leads to a contract. If you deliver a Medicaid service and would like to be reimbursed by Medicaid effective July 1, 2012 then you will need to complete an application. If you have an existing IPRS contract then you will need to complete an application in order to be eligible for a contract to be effective July 1, 2012 Yes, any licensed clinician that provides a billable service will need to complete the Uniform to Participate as a Healthcare Practitioner. If OP services are not provided then the Licensed clinician does not need to complete this application. As of 3/26/12, Provisional Licensed Clinicians employed by an agency will need to complete the credentialing process. Page 1 of 14

2 Do Provisional Licensed Clinicians have to be credentialed? No, SHC does not contract with Provisionally licensed staff. Those Provisionally Licensed staff employed with an agency will need to submit a Uniform application. How do we handle this with licensed practitioners (masters and physician level) who practice with us exclusively BUT as independent contractors? I am submitting Agency and Uniform s, when are they due? I am writing as a NC Licensed Psychologist and as an independently enrolled Medicaid provider delivering outpatient mental health services in Guilford County. Would you please advise me of any steps which need to be taken to ensure my ability to keep seeing Sandhills Center Medicaid eligibles. Any clinicians that you contract will need to complete the Uniform if they are going to serve Sandhills Center Medicaid eligibles Both applications can be submitted by the January 31st deadline. As an agency/facility you are required to complete the Provider Corporate Endorsement/Credentialing Service and each licensed clinician that provides services are required to submit the Uniform to Participate as a Healthcare Practitioner. I currently have a MOA with Sandhills Yes mental health, substance abuse, Center. Do I complete this credentialing and developmental disability providers process? that bill Medicaid in the Sandhills Center catchment area have to complete the credentialing process with Sandhills Center. I received the memo from you regarding Network Credentialing s. If we are already a Medicaid provider do we need to apply? Is this an additional level of enrollment? I would like to confirm that our agency will need to complete the agency Medicaid application, IPRS agency application, trading partner agreement and also if each licensed therapist employed by our agency will need to complete the Uniform (provisionally licensed staff are not included). Is Sandhills going to offer the Community Guide? Yes, an application will need to be completed in order to be reimbursed by Medicaid for behavioral health services for enrollees/consumers from any of the Sandhills Center 8 counties. NOTE: this would also address reimbursement for State funding (IPRS). You will need to complete the Provider Corporate Endorsement/Credentialing and Service ; Medicaid and IPRS services are included in this application. Each licensed and provisionally licensed staff would need to submit the Uniform along with the Trading Partner Agreement. Yes, Community Guide will be offered through the NC Innovations Waiver. These services are on page 19 of the provider corporate application. Page 2 of 14

3 Is this a new credentialing process Yes, all providers must complete the because I am already credentialed. How appropriate application and submit by would you know what LME to request authorization from for a particular member? the deadline. Authorization requests would be based on member's home county. If an agency is located in another county that is NOT in the Sandhills Center catchment area and serves Sandhills Center consumers/enrollees, in Cumberland and Harnett Counties, how will the waiver affect those consumers/enrollees? Is this endorsement provided by Sandhills Center, or are we only to submit endorsements received from other LME's? The consumers/enrollees will only be impacted if a contract is NOT established. In order to be reimbursed for services provded to SHC members outside of the SHC catchment area, providers must have a contract in place to serve and be reimbursed effective July 1, The agency application as well as an Licensed Individual Practitioner application must be completed because the individual provides the counseling. Applicants are being credentialed by Sandhills Center in order to establish a contract to provide services to Medicaid eligibles effective July 1, You may submit NEA letters as support for the services you have been approved to deliver but it is not a substitute for application completion and submission. Does a Piedmont agency need to Submit only if you want to serve complete the corporate application and Sandhills Center Medicaid eligibles the Uniform to Participate effective July 1, As a prospective for each licensed clinician? provider or agency/facility you must apply for and be credentialed by Sandhills Center. The correct application for an agency/facility is Provider Corporate. If the agency/facility has Licensed Independent Practitioners on staff then submit the Uniform to Participate as a Healthcare Practitioner for each licensed clinician and submit to Sandhills Center by January 15, Page 3 of 14

4 If a provider has an existing MOA with Sandhills Center and provides Intensive In Home services what application is to be completed? We also have Licensed Practitioners as team leads, what application should they submit? The provider completes the Corporate and each licensed professional completes the Uniform to participate as a Health Care Practitioner. NOTE: Licensed practitioners who deliver OP services are to submit the Uniform. If they are linked to a service such as Intensive in Home it is the responsibility of the agency that is approved to provide Intensive in Home to credential their own employees. If a provider has not been in business for a year; therefore an annual audit The provider must submit a written explanation stating that they have not has not been completed, does Sandhills been in business for a year and do not Center need a copy of the insurance certificate for each employee of the agency since the employees transport have an audit or financial statement to submit with the application. Sandhills Center does not need a copy of all your consumers to/from appointments using employees' auto insurance. Please personal vehicles? submit an agency insurance certificate that contains "Non-owned" auto coverage (See Medicaid Credentialing and Re-credentialing Criteria). If a Licensed Clinical Social Worker has As a LCSW you will be required to already been setup with Medicaid, does submit the Uniform to the practitioner need to complete an application? Participate as a Health Care Practitioner. Sandhills Center has been approved to become a Medicaid Waiver site, therefore all Behavioral Health Medicaid providers who have a current agreement with Sandhills Center or who bill directly to Medicaid must obtain a contract with Sandhills Center prior to July 1, 2012 if they desire to serve Sandhills Center eligible enrollees. If an agency employs a certified (CSACI) intern billing Y-codes only (no Medicaid) does the CSACI need to complete the application? Complete the Uniform with all information that applies, the OP service code list in the application will show that he/she only bills Y-codes. Page 4 of 14

5 As indicated in the criteria for Innovations Waiver services, the provider must attest that State Nursing Board Regulations are being followed. You can locate Service Definitions for the NC Innovations Waiver on the DHHS website ( on page 62 of the Innovations Waiver. Where can the specific regulations for Respite, Personal care, Crisis Behavioral Consultation, and In home Building Skills be found? Clarify time lines for credentialing? The time frames were simply a way to break up receipt of the different applicants to the network. We need the all applications by March 1, 2012, beyond that we cannot ensure that a contract will be in place by July 1, We are a corporation and have recently been accredited with CQL. We provide CAP services in the Sandhills Center catchment area. I was advised to ask if we will need to complete the Provider Self Assessments and Policy and Procedures? As an agency that is accredited and is an existing provider you will not need to submit the Policy and Procedures, Core Rules, or Self Assessment. As of 3/7/12 per DMA, SHC is required to collect Policies and Procedures/Core Rules from all endorsed agencies NOT ENDORSED BY SHC. We have an MD, a Nurse Practitioner All employees directly enrolled with and several Licensed Therapists that Medicaid or bill under their own license are all employees with their own have to complete the Uniform Medicaid numbers. Do we fill out to Participate as a Health individual applications for them? Do we Care Practitioner if they deliver a submit those with our agency app since Medicaid reimbursable service. we will do their billing? We have already completed PBH Yes, this credentialing process is for the credentialing process, is this application Sandhills Center 8 county catchment only for Sandhills Center? area only. We received an enrollment letter, do we need to complete the enrollment process? Yes, if your agency bills Medicaid for any behavioral health services for consumers in the Sandhills Center catchment area the agency will need to complete the Provider Corporate. Any clinicians associated with billing behavioral health services with the agency will need to complete the Uniform. Page 5 of 14

6 What application should be submitted for a corporation? Also, what application is needed for licensed provisional clinicians and where do we locate the applications on the website? Agencies submit the Provider Corporate. Licensed clinicians are to complete the Uniform to Participate as a Health Care Practitioner. The applications are located on the Sandhills Center website. Go to click on the For Providers link, then click on the "Selecting an " link. What application should we submit to Sandhills Center for a private practice providing services for Adolescent, The correct application is the Provider Corporate Endorsement/Credentialing and Service and the Trauma? We have a contract to provide Uniform will need to be services with Sandhills Center. completed for each licensed practitioner, etc. Also the agency and Licensed practitioners are required to submit the Trading Partner Agreement. If I am an existing provider of CAP services do I have to complete a new application? Yes, everyone who bills for MH/DD/SA services both Medicaid and IPRS will be required to complete an application to be credentialed. 1. If you are an existing provider you do not have to submit this information. and Service do we complete Only new providers will need to submit pages and pages of the this information. Corporate application? 2. Call or register online by doing the following: Go to What IRS documentation is Sandhills Center looking for? IRS.gov, click on tax professionals, click on E-Services for Tax Pros, click on Registration Services then complete registration. As of 3/21/12 IRS documentation is no longer required for provider to submit. This will be verified through the LME's request of good standing from DMA. Corporate and Service is the organization address supposed to be corporate or local? Submit a copy of your HR policy that indicates background checks are and Service, Section I, completed and the signed employee question 2: form used to request the background Do you want us to include a copy of check. Please submit an example of every staff member's background check each of the ones noted in the question or just our policy indicating we perform (owners, director, officers, them? administrators, and staff). Page 6 of 14

7 and Service, the question noting the number of years doing business. Is this in NC or as an agency? As an agency. and Service, Section I, question 12: What do we do? This is a nonprofit organization with no owners. and Service, Section II, question 11: What type of entity would qualify as a reference for our fiscal operations? and Service, question 12, asks for all information on officers, directors, and manager. There are several offices and directors, not to mention 5 offices that serve Sandhills, would we want to do the managers of each of those offices as well? and Service, Section III, page 11: Do I need to duplicate this for each office serving the Sandhills area? Am I required to submit a Uniform to Participate as a Health Care Practitioner for my Medical Director if she does not have a private practice and is under contract with my agency? Respond with N/A and attach a short explanation as to why it does not apply to your organization. The company that performs the financial reviews are acceptable for a reference of the fiscal operations. Copy the page and list all that apply. Yes, duplicate page 11 for each site serving Sandhills catchment area eligible Medicaid enrollees. Yes, if the Medical Director and all Licensed Independent Practitioners deliver a Medicaid reimbursable service they must complete the Uniform. Also, the agency must submit the Provider Corporate. Please be advised that the agency and all practitioners must submit the Trading Partner Agreement with their applications. Are there two separate applications No, just complete the Uniform that the Licensed Individual Practitioner. The "Medicaid and IPRS must complete for IPRS and Medicaid? Service List" are part of the application. Complete the IPRS Service List only if you are a current IPRS contract provider with Sandhills. Page 7 of 14

8 Are we looking for a list of Medicaid numbers for all the consumers on page 3 of the Provider Corporate application? No, here is where you list the facility Medicaid ID # for the site and/or sites you are applying for. Are we required to send our policy and procedure manual? As long as the agency has an endorsed site within the SHC catchment area the self study of core rules and policy and procedure manual are not required to be submitted. You may submit the NEA letters indicating your "endorsement" for the and Service are you asking services you have been approved to for copies of the previous endorsement provide along with the business for the specific site/service, or just for verification. the corporate verification endorsement? Can Sandhills Center confirm that the LCSW and LPC boards perform primary source verification or does the provider need to provide transcripts for each licensed therapist, LCSW, and LPC? and Service a letter of reference is requested. Can the reference letter be typed? The respective Boards complete primary source education verification prior to licensure. If you are licensed as an LCSW or LPC it is not necessary to submit transcripts but you will need to submit a copy of the license. Sandhills Center staff will complete the primary source verification. Yes, as long as it has the original signature that is fine. If you have completed an application in the past for the service(s) you are now and Service, Section III, applying for check "yes" and attach page 11 asks if we have ever completed documentation regarding the results of an application for the service in the the request (i.e. NEA letter, denial past with Sandhills Center, please letter). clarify. If an agency has multiple site locations and are CARF accredited, do they need to complete the Self Assessment and Core Rules? If you are an existing provider you do not need to submit the Core Rules or Policies & Procedures. As an accredited agency your Policies & Procedures have been reviewed by your accrediting agency. As of 3/7/12 per DMA, SHC is required to collect Policies and Procedures/Core Rules from all endorsed agencies NOT ENDORSED BY SHC. Page 8 of 14

9 Do I need to complete an application since I am an agency already enrolled? Do I complete page 6? I have one NPI number for several services is that ok? All providers have to complete an application and have an established contract in place if you desire to continue serving Sandhills Center Medicaid eligibles effective July 1, Yes, complete page 6. It is ok to only have one NPI number. and Service, do I complete Section III based on office or site address only, for each service separately, or based on the group billing number currently assigned for by NC Medicaid? Site address only. It is not necessary to complete this for each service. Complete one time, noting the services to be provided at that site location. and Service, does my agency have to complete page 9 or can I just send the verification from their home LME? Page 9 will need to be completed. Sandhills Center will not except verification from the home LME. Do we have to complete the entire In order to be reimbursed for any Provider Corporate/Endorsement consumer/enrollee within the Sandhills Credentialing and Service Center catchment area as of July 1,2012 although we are not in Sandhills Center you will have to complete the entire catchment area? Can we choose the application. Corporate Endorsement by Other LME on the application and only complete Section III? and Service, does a nonprofit organization have to complete question 12 about the 5% shareholder, because there are no owners, only employees and board members? Do all Licensed Individual Practitioners that provide services for an agency have to complete an enrollment application? Is January 15, 2012 the deadline date or January 31 with the agency application? If there are no owners respond with "N/A" and attach a short explanation as to why it does not apply to your organization. However, question #12 also asks to list all individual officers, directors, managers and (Electronic Funds Transfer) authorized individuals and information requested for each. Yes, all Licensed Individual Practitioners that provide services for the agency (that serve Sandhills Center enrollees) have to complete the Uniform. Sandhills Center is asking that Licensed Individual Practitioner applications be returned by Jan. 15, It is important that all applications be in by March 1,2012. s received after this date cannot be guaranteed a contract will be in place by July 1, Page 9 of 14

10 Is an agency that only provides outpatient mental health counseling services required to complete the Provider Corporate Yes, the agency will need to complete the Provider Corporate. Each independent licensed clinician must submit the Uniform? to Participate as a Health Care Practitioner. Does Sandhills Center want the college/university to submit original transcript of the Licensed Individual Practitioner? No. An unofficial copy from the clinician is sufficient. However, there is no need to submit this information if your licensing board completes primary source verification on education prior to licensure. You will need to ensure the license is submitted. Sandhills Center staff will complete primary source verification on the license. Provider Corporate If there are no owners respond with "N/A" and attach a short explanation as pages 6 and 7 ask about to why it does not apply to your shareholders and owners. As a nonprofit organization how do we address also asks to list all individual officers, organization. However, question #12 this question? directors, managers and (EFT) authorized individuals and information requested for each. On the Uniform Instruction page 2, Item #4, bullet #1, the version date on any of the documents that comprise the provider enrollment packet is prior 12/13/2011. Was does the version date 12/13/2011 mean? On the Uniform to Participate as a Healthcare Provider, is the ownership on page 17 left blank if there are no other owners? A prospective Licensed Independent Practitioners must apply for and be credentialed as practitioner using the current Uniform to Participate as a Health Care Practitioners. This application is dated 12/13/2011 in the left hand side of application. This simply means that an application prior to this date is not acceptable. If there are no other owners that have 5% or more ownership, respond with N/A with short explanation simply stating that there are no other owners. Is the Self Study of Core Rules located The self study of core rules are pages in the Provider Corporate of the Provider Corporate application.? Is the Self-Assessment/QI the same as the Self Study of Core Rules? Yes, already accredited and existing providers are not required to submit the self study of core rules although we will be looking for these items during the on-site review. Corrected 3/1/12 Page 10 of 14

11 On the Licensed Individual Practitioner application, is the provider ID# the The provider ID# is the Medicaid ID# and yes complete Section II in order to Medicaid ID#? Also, does page 10 apply participate in the Medicaid waiver. to us Licensed Individual Practitioners? On the Licensed Individual Practitioner applications, you request IRS documentation indicating that there are no unresolved tax or payroll liabilities. What are you looking for? There are 5 Licensed Individual Practitioners waiting to submit their applications. In regards to your question regarding IRS documentation, we suggest that you contact the Internal Revenue office and request a letter indicating that you have no unresolved tax or payroll liabilities. However, the application may be submitted to Sandhills Center with a note attached indicating that you have requested a letter from IRS. If the Licensed Individual Practitioners just work for the agency the IRS statement is not required. Only the agency would be required to provide this information. On page 11 of the Provider Corporate If you have applied for the service(s) you are currently making application to it asks: Have you ever deliver please submit the results (i.e. completed a Sandhills Center NEA letter or denial). application for this service in the past? If yes, what year? Regarding the Independent Practitioners application forms for practitioners that are part of a agency, do these applications go in at the same time as the Agency/Facility applications? Which deadline of 1/31/2011 or 1/15/2012 is correct? All Licensed Practitioners are required to be credentialed and will need to complete and submit the Uniform to Participate as a Healthcare Practitioner. If you work for an agency/facility and do not have a solo practice please coordinate the application submission with your employer. The due date for Licensed Individual Practitioner applications is January 15, 2012 and for Agency/Facilities the due date is January 31,2012. Corporate To demonstrate that you employ the staff needed that is compliant with the, what is # 9, item j asking service definition. for when it says staffing pattern? Page 11 of 14

12 To be clear, our current corporate LME is Wake, we provide CAP, MRDD, and IPRS services for adults and children with IDD with both Guilford and Sandhills LMEs. We have physical sites in Guildford County and Cumberland County where these services are currently supervised from. Do we need to complete all sections of the application or only Section III? The entire application will need to be completed. NOTE: the application stipulates submitting the core rules/policy and Procedures. Your agency will not need to submit those as part of the application as you are an existing provider. As long as the agency has an endorsed site within the SHC catchment area the self study of core rules and policy and procedure manual are not required to be submitted. What is the deadline to submit an application for an agency that provides CAP, Personal Care, Respite, and Home & Community? What license # are you looking for on page 17 of the Uniform? What type of IRS documentation is Sandhills Center looking for? Where do I get the application for Network Participation? Which application do I complete? We do both Medicaid and IPRS? Which application do I complete? Will this application cover Guilford? We are already endorsed, do we complete the corporate section? Which application do we complete? We are in Mecklenburg county and currently have an MOA with Sandhills Center for CAP services. The deadline to submit your application is January 31, Your professional license #. You can request a letter of good standing by calling or register on-line by doing the following. Go to IRS.gov, click on tax professionals, click on E-Services for Tax Pros, click on Registration Services, then complete registration. Go to click on the For Providers link, then click on the "Selecting an " link. Complete the entire provider corporate application for the agency (Medicaid) as well as all clinicians should complete the Uniform. There is a service list with these applications that specify Medicaid and IPRS funding. Complete the entire Provider Corporate. No, this Sandhills Center credentialing process covers the Sandhills Center 8 county catchment area. Complete the Provider Corporate. Page 12 of 14

13 Which box applies for providing only CAP services on the provider application on page 3? The Corporate Endorsement and New Agency Provider Service for Sandhills Center Network Enrollment, because this is a brand new credentialing process for Sandhills Center and all information is collected as if it is a brand new provider. Which application do we complete? We do no Medicaid billing. Which application do we need to complete since we provide Medicaid and IPRS services. Why can't we as an existing provider complete certain sections of the provider corporate application? Complete the IPRS only application if it is for a service that is only funded by IPRS. Existing IPRS providers are required to apply if they want to continue to provide IPRS services effective July 1, Complete the Provider Corporate. This application has a Medicaid Service List and an IPRS Service List to document the services you deliver for each funding source. This is a brand new credentialing process for Sandhills Center. All information is required. NOTE: if you are an existing provider it is not necessary to submit Core Rules and the Policy and Procedure manual. As of 3/7/12 per DMA, SHC is required to collect Policies and Procedures/Core Rules from all endorsed agencies NOT ENDORSED BY SHC. Will it be okay if Sandhills Center That is fine, you will not be penalized receives an application in the 2nd week for not making the January 31st date. in February, past the January 31,2012 All application must be received by due date? March Does an agency that has its corporate Yes, the entire application must be office outside of the Sandhills Center completed. area have to complete the entire Provider Corporate? Page 13 of 14

14 Other Can a non-licensed person provide and bill for substance abuse counseling under the license of a supervised LPC? They would be able to bill IPRS YP codes , they cannot bill Medicaid. Do I need a complete personnel file for a psychiatrist that only does consultant work? If the consultant is billing Medicaid for services delivered on your agency's behalf the answer is yes. Does Sandhills Center have the No we do not. contingency Management Program? When is the next NC-SNAP training? The next NC-SNAP training is scheduled for February 3, 2012 at the Murdoch Training Center in Butner from 1-4pm. To register for this training please contact Sonya Bridges at SonyaP@sandhillscenter.org. Utilization Management How does an agency get signed up for ProviderConnect? How does she get a password for ProviderConnect? Is there a problem with signing on to ProviderConnect? When will there be training for ProviderConnect? Instructions are located on the Sandhills Center website ( There is a ProviderConnect direct along with the ProviderConnect user guide. The provider must pconn@sandhillscenter.org for any ProviderConnect issues. Instructions are located on the Sandhills Center website ( There is a ProviderConnect direct along with the ProviderConnect user guide. The provider must pconn@sandhillscenter.org for any ProviderConnect issues. Instructions are located on the Sandhills Center website ( Any log on issues are to be ed to: pconn@sandhillscenter.org. The trainer is in transition. Sandhills Center will notify agencies when a trainer has been identified. Page 14 of 14