Emergency Department Claims from Out-of-Network Hospitals

Claims from out-of-network hospitals for services provided in the emergency department to Sandhills Center Medicaid members can be billed directly. Hospitals will need to complete an ED Reimbursement Request Form, a Trading Partner Agreement and a copy of their W-9.

• Emergency Department Cover Letter
• Emergency Department Reimbursement Request Form
• Trading Partner Agreement
• W-9 Form

Please submit the forms by email, fax or mail.

Email Address: EDassignments@SandhillsCenter.org

Fax Number: (910) 673-7013

Mailing Address:

Sandhills Center
Attn: ED Enrollments
P.O. Box 9, West End, NC 27376

Once your reimbursement request form (application) has been reviewed, you will be enrolled as a provider of Emergency Department services and will be eligible for billing options as outlined on the form. For inquiries regarding this reimbursement/application process or status, please contact Lori Kirk at 910-673-7520, or via email at EDassignments@SandhillsCenter.org.