IMPORTANT NEW INSTRUCTIONS FOR MEMBER ELIGIBILITY

AND ENROLLMENT

Effective Immediately

When a Provider wishes to enroll a member into the Sandhills Center LME/MCO the following steps should be followed:

1) Access Provider Connect and look up member to ascertain if member

has a Medical Record Number already assigned.

  • For IPRS members, utilize the Lookup Client tab to verify whether or not a Medical Record Number has ever been assigned to the member. If there is no Record Number assigned, the Provider is to complete the Consumer Admission Form, entering zeros in the Medical Record Number slot. (The Provider can access Provider Connect within two (2) business days to obtain the member’s Medical Record Number, using the member’s name or date of birth to identify the member. If the Provider is unable to identify member’s number, they can contact ME&E at 1-800-256-2452.)
  • For Medicaid members, the Provider needs to click “Add New Client/Client Search”. Enter the member’s Medicaid number (required) and click “Search”. If the member has never been enrolled with the LME/MCO and a Record Number has not been assigned previously, the Provider will be prompted to “Create Admission”. For these members the Provider creates the admission in Provider Connect, and does not need to complete the Consumer Admission Form on the SandhillsCenter website. If the member has a Record Number assigned, click on the blue Record Number and proceed to completion of the Treatment Authorization Request (TAR).

2)Upon receipt of the Consumer Admission Form:

  • If a Record Number is already assigned, ME&E staff will update demographic information and enter newly submitted information.
  • If there is no Record Number assigned, ME&E staff will research the member confirming that no prior Medical Record Number has been assigned, assign a Record Number, and submit information on Consumer Admission Form into the Avatar system.(The Provider can access Provider Connect within two (2) business days to obtain the member’s Medical Record Number, using the member’s name or date of birth to identify member. If the Provider is unable to identify member’s number, they can contact ME&E at 1-800-256-2452.)