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We expect this process to be seamless for our valued members, and there will be no break in their coverage. A. N .7$* P!70 *I;Rox3 ] LS~. Please use WellCare Payor ID 14163. Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. For the death or injury of a member of the South Carolina National Guard, as provided for in Section 42-7-67, the time for filing a claim is two years after the accident or one year after the federal claim is finalized, whichever is later. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. You will need Adobe Reader to open PDFs on this site. hYnH~}9'I`@>cLq,&DYH"W~&eJx'"luWU]JDBFRJ!*SN(s'6# ^*dg4$SB7K4z:r6')baka+Raf4J=)l, _/jaSpao69&&_Ln=?/{:,'z .1J0|~jv4[eUN{:-gl! K'&hng?y},&X/|OzcJ@0PhDiO})9RA9tG%=|rBhHBz7 Select your topic and plan and click "Chat Now!" to chat with a live agent! All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. Please contact our Provider Services Call Center at 1-888-898-7969. Farmington, MO 63640-3821. The benefit can be used to get more than 150 items - including vitamins, pain relievers, cold and allergy medicines, baby wipes, and diapers - at no cost . The hearing officer does not decide in your favor. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required tofollow. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. The member will be encouraged to establish care with a new in network PCP/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. DOS prior to April 1, 2021: Processed by WellCare. Q. Symptoms are flu-like, including: Fever Coughing In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Contact Wellcare Prime Provider Service at 1-855-735-4398 if you have questions. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. A. Medicaid Claims Payment Policies A. You can file a grievance by calling or writing to us. You will have a limited time to submit additional information for a fast appeal. Wellcare uses cookies. 941w*)bF iLK\c;nF mhk} Wellcare wants to ensure that claims are handled as efficiently as possible. Because those authorizations will automatically transfer to Absolute Total Care, it is not necessary to request the authorization again when the member becomes eligible with Absolute Total Care. Hearings are used when you were denied a service or only part of the service was approved. Download the free version of Adobe Reader. For dates of service on or after 4/1/2021: Professional and Institutional Fee-For-Service/Encounter EDI transactions should be submitted to Absolute Total Care Medicaid with Payer ID <68069> for Emdeon/WebMD/Payerpath or <4272> for Relay Health/McKesson. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. You can do this at any time during your appeal. * Username. Or it can be made if we take too long to make a care decision. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Timely Filing Limit: Timely Filing Limit is the time frame set by insurance companies and provider has to submit health care claims to respective insurance company within the set time frame for reimbursement of the claims. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. Learn more about how were supporting members and providers. Click below for more information from Absolute Total Care: You are now able to view your health information from a third-party app on a mobile device or PC! Wellcare uses cookies. 1044 0 obj <> endobj Providers will continue to work directly with WellCare to address any claims for dates of service prior to the membership transfer of April 1, 2021. It is called a "Notice of Adverse Benefit Determination" or "NABD." Initial Claims: 120 Days from the Date of Service. The current transaction means that WellCare of South Carolina Medicaid members are transitioning to Absolute Total Care and will become Absolute Total Care members, effective April 1, 2021. Keep yourself informed about Coronavirus (COVID-19.) No, Absolute Total Care will continue to operate under the Absolute Total Care name. endstream endobj startxref We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` How do I bill a professional submission with services spanning before and after 04/01/2021? Additionally, WellCare will have a migration section on their provider page at publishing FAQs. We understand that maintaining a healthy community starts with providing care to those who need it most. For requests involving dates of service on April 1, 2021 and beyond, Absolute Total Care will follow Medicaid contract requirements allowing a 90-day transition of care period. Q. hbbd``b`$= $ You do not appeal within 10 calendar days from when the Plan mails an adverse Notice of Action, or you do not request a hearing within 10 calendar days from when the Plan mails an adverse Notice of Appeals Resolution whichever is later. Columbia, SC 29202-8206. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. We will call you with our decision if we decide you need a fast appeal. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on April 1, 2021. A. From time to time, Wellcare Health Plans reviews its reimbursement policies to maintain close alignment with industry standards and coding updates released by health care industry sources like the Centers for Medicare and Medicaid Services (CMS), and nationally recognized health and medical societies. The state has also helped to set the rules for making a grievance. If Medicare is the primary payer, timely filing is determined from the processing date indicated on the primary carrier's explanation of benefit (EOB) If Medicare is the Secondary Payer (MSP), the initial claim must be submitted to the primary payer within Cigna's timely filing period. pst/!+ Y^Ynwb7tw,eI^ Wellcare uses cookies. 837 Institutional Encounter 5010v Guide Absolute Total Care will honor those authorizations. Providers are encouraged to visit the Provider Resources page at absolutetotalcare.com for manuals, forms and resources related to claims submission, eligibility, prior authorization and more. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Download the free version of Adobe Reader. All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access healthcare services starting April 1, 2021. Here are some guides we created to help you with claims filing. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. We will also send you a letter with our decision within 72 hours from receiving your appeal. Please see list of services that will require authorization during this time. You may request a State Fair Hearing at this address: South Carolina Department of Health Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. The provider needs to contact Absolute Total Care to arrange continuing care. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Need an account? 2023 Medicare and PDP Compare Plans and Enroll Now Notice of Non-Discrimination We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, sex, or disability. Absolute Total Care will honor those authorizations. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. Paper Claim Submission Submit paper claims to: WellCare Health Plans Electronic Claim Submission To initiate electronic claims, both in-network and out-of-network providers should contact their practice management software vendor or EDI software vendor. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Where should I submit claims for WellCare Medicaid members? We are proud to announce that WellCare is now part of the Centene Family. Do I need to do anything additional to provide services on or after 4/1/2021 if I am in network with both WellCare and Absolute Total Care? In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Wellcare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. Providers will continue to follow WellCares Medicaid policies and procedures for services provided to WellCare Medicaid members for dates of service prior to April 1, 2021. Q. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Providers will follow Absolute Total Care Medicaid policies and procedures for all services, inclusive of medical, behavioral, and pharmaceutical benefits, provided to WellCare Medicaid members transitioning to Absolute Total Care for dates of service on or after April 1, 2021. To continue providing transition of care services, providers that are not part of the Absolute Total Care Network must agree to work with Absolute Total Care and accept Absolute Total Cares payment rates. Beginning, March 14 March 31, 2021, please send to WellCare, April 1 April 3, 2021, please send to Absolute Total Care, DOS prior to 4/1/2021- Processed by WellCare, DOS 4/1/2021 and after- Processed by Absolute Total Care, Date of Occurrence/DOS prior to 4/1/2021- Processed by WellCare, Date of Occurrence/DOS 4/1/2021 and after- Processed by Absolute Total Care. A. WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare Primary Care Physician (PCP) as if the PCP is in network with Absolute Total Care. It will let you know we received your appeal. Timely filing limits vary. $8v + Yu @bAD`K@8m.`:DPeV @l To avoid rejections please split the services into two separate claim submissions. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. Ambetter from Absolute Total Care - South Carolina. Provider can't require members to appoint them as a condition of getting services. Please note - a representative may file for a member who: If the members request for appeal is submitted after 60 calendar days from the date on the NABD, then good cause must be shown in order for WellCare to accept the late request. We welcome Brokers who share our commitment to compliance and member satisfaction. Transition/continuity of care is an extended period of time members are given when they join or transfer to another plan in order to receive services from out-of-network providers and/or pharmacies, until that specified period ends. 1071 0 obj <>/Filter/FlateDecode/ID[<87133B316ADA4BDD8B85BA48A489D34F>]/Index[1044 53]/Info 1043 0 R/Length 117/Prev 692690/Root 1045 0 R/Size 1097/Type/XRef/W[1 2 1]>>stream Division of Appeals and Hearings Q. An appeal is a request you can make when you do not agree with a decision we made about your care. WellCare is the health care plan that puts you in control. Please make sure you ask your members for a copy of their Absolute Total Care and Healthy Connections Choices Medicaid ID cards before each visit. Pregnant members receiving care from an out-of-network Obstetrician can continue to see their current obstetrician until after the baby is born. Timely filing is when you file a claim within a payer-determined time limit. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. They must inform their vendor of AmeriHealth Caritas . Q. A. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Box 6000 Greenville, SC 29606. Absolute Total Care Please Explore the Site and Get To Know Us. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. Claims Department Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Please use the Earliest From Date. P.O. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy BlueCross BlueShield of South Carolina Piedmont Service Center P.O. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. Go365 for Humana Healthy Horizons Members can register for the new Go365 for Humana Healthy Horizons wellness program and earn rewards for participating in healthy activities. Providers do not need to do anything additional to provide services on or after 4/1/2021 if the provider is in network with both WellCare and Absolute Total Care. Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. You must file your appeal within 60 calendar days from the date on the NABD. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Q. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. WellCare offers participating providers EFT and ERA services at no charge through PaySpan Health. 3) Coordination of Benefits. P.O. Section 1: General Information. Awagandakami You and the person you choose to represent you must sign the AOR statement. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Visit https://msp.scdhhs.gov/appeals/ to: Copyright 2023 Wellcare Health Plans, Inc. https://msp.scdhhs.gov/appeals/site-page/file-appeal, If we deny or limit a service you or your doctor asks us to approve, If we reduce, suspend or stop services youve been getting that we already approved, If we do not pay for the health care services you get, If we fail to give services in the required timeframe, If we fail to give you a decision in the required timeframe on an appeal you already filed, If we dont agree to let you see a doctor who is not in our network and you live in a rural area or in an area with limited doctors, If you dont agree with a decision we made regarding your medicine, We denied your request to dispute a financial liability, The member did not personally receive the notice of action or received the notice late, The member was seriously ill, which prevented a timely appeal, There was a death or serious illness in the members immediate family, An accident caused important records to be destroyed, Documentation was difficult to locate within the time limits; and/or the member had incorrect or incomplete information concerning the appeals process, Change the appeal to the timeframe for a standard decision (30 calendar days), Follow up with a written letter within 2 calendar days, Tell you over the phone and in writing that you may file a grievance about the denial of the fast appeal request, Be in writing and specify the reason for the request, Include your name, address and phone number, Indicate the date of service or the type of service denied, Your authorized representative (if youve chosen one), A hearing officer from Medicaid and Long-Term Care (MLTC), You or your authorized representative with your written consent must file your appeal with us and ask to continue your benefits within 10 calendar days after we mail the Notice of Adverse benefit determination; or, Within 10 calendar days of the intended effective date of the plans proposed action, whichever is later, The appeal or hearing must address the reduction, suspension or stopping of a previously authorized service, The services were ordered by an authorized provider, The period covered by the original authorization cannot have ended. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. R 1/70.3/Determining End Date of Timely Filing Period -- Receipt Date R 1/70.4/Determination of Untimely Filing and Resulting Actions R 1/70.5/Application to Special Claim Types R 1/70.6/Filing Claim Where General Time Limit Has Expired R 1/70.7/Exceptions Allowing Extension of Time Limit R 1/70.7.1/Administrative Error Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Absolute Total Care will honor those authorizations. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. When can providers begin requesting prior authorization from Absolute Total Care for WellCare Medicaid members for dates of service on or after April 1, 2021? endstream endobj 1045 0 obj <>/Metadata 50 0 R/OpenAction 1046 0 R/Outlines 160 0 R/Pages 1042 0 R/StructTreeRoot 166 0 R/Type/Catalog/ViewerPreferences<>>> endobj 1046 0 obj <> endobj 1047 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC/ImageB/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 1048 0 obj <>stream Our call centers, including the nurse advice line, are currently experiencing high volume. You will receive an acknowledgement letter within 5 business days, and we will send you a resolution within 90 calendar days. Q. To write us, send mail to: You can fax it too. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. Prior authorizations issued by WellCare for dates of service on or after April 1, 2021 will transfer with the members eligibility to Absolute Total Care. Providers are encouraged to visit the Provider Resources webpageformanuals, forms, clinical policies, payment policies, provider news and resources related to claims submission, eligibility, prior authorization and more. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. P.O. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. Copyright 2023 WellCare Health Plans, Inc. WellCare Non-Emergency Medical Transportation (NEMT) Update, Provider Self-Service Quick Reference Guide (PDF), Provider Masters Level Proposed Rates (PDF), Member Advisory Committee (MAC) Member Flyer (PDF), Member Advisory Committee (MAC) - LTSS Member Flyer (PDF), Managed Care PHP Member PCP Change Request Form (PDF), Provider Referral Form: LTSS Request for PCS Assessment (PDF). With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. WellCare of South Carolinawants to ensure that claims are handled as efficiently as possible. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. Copyright 2023 Wellcare Health Plans, Inc. We may apply a 14 day extension to your grievance resolution. Member Sign-In. North Carolina PHP Billing Guidance for Local W Code. Federal Employee Program (FEP) Federal Employee Program P.O. Providers can begin requesting prior authorization for pharmacy services from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on April 1, 2021. Wellcare uses cookies. Claim Filing Manual - First Choice by Select Health of South Carolina Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Those who attend the hearing include: You can also request to have your hearing over the phone. For dates of service on or after April 1, 2021: Absolute Total Care Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after 4/1/2021 from Absolute Total Care on March 15, 2021. Select Health Claims must be filed within 12 months from the date of service. Examples of good cause include, but are not limited to, the following: We will send you a letter within five business days of getting your appeal. The participating provider agreement with WellCare will remain in-place after 4/1/2021. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. You can also have a video visit with a doctor using your phone or computer. You can get many of your Coronavirus-related questions answered here. This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. WellCare of North Carolina Medicaid providers are not required to obtain an authorization for professional services for the 90-day post-go live period from July 1, 2021 through September 28, 2021. 0 If you ask for a fast appeal and we decide that one is not needed, we will: You or your authorized representative can give us more information if you think itll help your appeal (regular or fast). z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Copyright 2023 Wellcare Health Plans, Inc. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) Member Appeals (Medical, Behavioral Health, and Pharmacy): Copyright 2023 Wellcare Health Plans, Inc. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. To do this: If you dont agree with our appeal decision - and you've completed the appeal steps with our health plan - or, if our appeal decision was not made within the required timeframe (30-calendar days for standard appeals or 72 hours for fast appeals), you may request a State Fair Hearing. They are called: State law allows you to make a grievance if you have any problems with us. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . Only you or your authorizedrepresentative can ask for a State Fair Hearing. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Addakam ditoy para kenka. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Prior authorizations issued by WellCare for dates of service on or after 4/1/2021 will transfer with the members eligibility to Absolute Total Care. Guides Filing Claims with WellCare. Explains how to receive, load and send 834 EDI files for member information. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. As a member you may request a 14 day extension of your grievance, you may do so by calling Member Services at 1-888-588-9842 (TTY 1-877-247-6272) or You may send your request for extension in writing to: WellCare Health Plans WellCare Medicaid members migrating to Absolute Total Care will be assigned to their assigned WellCare primary care provider as if the primary care provideris in network with Absolute Total Care. You can ask for a State Fair Hearing after we make our appeal decision. Q. Please use the earliest From Date. We will send you another letter with our decision within 90 days or sooner. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. You can file an appeal if you do not agree with our decision. If your services are continued during an appeal or a hearing, you can keep getting them until: If the hearing is decided in your favor, well approve and pay for the care that is needed. Or you can have someone file it for you. Q. Providers interested in joining the Absolute Total Care provider network should submit a request to the Network Development and Contracting Department via email at atc_contracting@centene.com. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. Box 31384 The materials located on our website are for dates of service prior to April 1, 2021. ?-}++lz;.0U(_I]:3O'~3-~%-JM All transitioning Medicaid members will receive a welcome packet and new ID card from Absolute Total Care in March 2021 and will use the Absolute Total Care ID card to get prescriptions and access health care services starting April 1, 2021. For as long as your member has an active WellCare subscriber number, you should continue to submit claims directly to WellCare as you have in the past. We will give you information to help you get the most from your benefits and the services we provide.