Provider Payment Agreement for Out-of-Network Medicaid Providers

Provider Payment Agreements (PPAs) are for out-of-network providers to request reimbursement for services provided to Sandhills Center Medicaid members.

The PPA is subject to medical necessity review and is for retroactive episodes of care.

For hospitals, the PPA is used for inpatient care only. Services provided in the emergency department of a hospital do not require a PPA but should be billed directly.

For more information, please visit the Emergency Department Claims from Out-of-Network Hospitals page on the Sandhills Center website.

PPAs are reserved for crisis or urgent care services and should not be utilized for services that could be covered under a Single Case Agreement (SCA) which should be established prior to service provision.

Please note that the PPA request will need to be submitted through our Provider Support Portal.

Select “New Support Ticket”
Select Subject/Request Type “Request for Provider Payment Agreement (PPA)”
Enter the necessary information and attach only the required documentation that has been requested

Please also note that PPAs will no longer be accepted via mail, fax or email. If you have questions, contact Sandhills Center through the Provider Support Portal or by calling the Provider Help Desk at 1-855-777-4652.