For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. 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. How do I determine if a professional or an outpatient bill type institutional submission should be filed to WellCare or Absolute Total Care? Pregnant members receiving care from an out of network Obstetrician can continue to see their current Obstetrician until after the baby is born. Continuation of Benefits During the Appeals Process We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. 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. Claims Department All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. WellCare Medicare members are not affected by this change. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. P.O. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. hbbd``b`$= $ By continuing to use our site, you agree to our Privacy Policy and Terms of Use. A. This includes providing assistance with accessing interpreter services and hearing impaired . Members will need to talk to their provider right away if they want to keep seeing him/her. Select Health Claims must be filed within 12 months from the date of service. For the latest COVID-19 news, visit the CDC. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. Keep yourself informed about Coronavirus (COVID-19.) Or you can have someone file it for you. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. More Information Coronavirus (COVID-19) you have another option. March 14-March 31, 2021, please send to WellCare. Division of Appeals and Hearings A. Download the free version of Adobe Reader. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Wellcare uses cookies. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. Please use the From Date Institutional Statement Date. A. Q. 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. Explains how to receive, load and send 834 EDI files for member information. Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. N .7$* P!70 *I;Rox3 ] LS~. Q. Please use WellCare Payor ID 14163. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. Reimbursement Policies 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. The timely filing limit is the time duration from service rendered to patients and submitting claims to the insurance companies. 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. A. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at atc_contracting@centene.com. 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. %PDF-1.6 % Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. If you dont, we will have to deny your request. and Human Services Medicaid Claims Payment Policies You can file a grievance by calling or writing to us. 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. You may do this in writing or in person. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. Tampa, FL 33631-3372. Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. Authorizations already processed by WellCare for any services on or after April 1, 2021, will be moved to Absolute Total Care and there is no need for the provider or member to request these services again. We welcome Brokers who share our commitment to compliance and member satisfaction. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _ s As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. The second level review will follow the same process and procedure outlined for the initial review. Wellcare wants to ensure that claims are handled as efficiently as possible. 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. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. The state has also helped to set the rules for making a grievance. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! Members who are dealing with stress or anxiety can call our 24-Hour Behavioral Health Crisis Line at 1-833-207-4240 to speak with a trained professional. Timely filing limits vary. hb```b``6``e`~ "@1V NB, To ask for hearing, call 1-800-763-9087 or write to: You also can make a request online using SCDHHS form at https://msp.scdhhs.gov/appeals/site-page/file-appeal. (This includes your PCP or another provider.) 1044 0 obj <> endobj Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Box 3050 Forgot Your Password? 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. Q. Will Absolute Total Care continue to offer Medicare and Marketplace products? 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. Tampa, FL 33631-3372. Learn how you can help keep yourself and others healthy. All transitioning Medicaid members will receive a welcome packet and new member 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. 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. We are proud to announce that WellCare is now part of the Centene Family. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Please Explore the Site and Get To Know Us. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Ambetter Timely Filing Limit of : 1) Initial Claims. A. Want to receive your payments faster to improve cash flow? If you file a grievance or an appeal, we must be fair. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. You can do this at any time during your appeal. endstream endobj startxref 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. Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. If at any time you need help filing one, call us. PROVIDER REMINDER: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to 4/1/2021 if they are in the annual choice period. WellCare Health Plans, Inc. (NYSE: WCG) is now offering a $120 credit per family, per year towards over-the-counter (OTC) items as part of its Medicaid program benefits in South Carolina. For current information, visit the Absolute Total Care website. Always verify timely filing requirements with the third party payor. Wellcare uses cookies. Where should I submit claims for WellCare Medicaid members that transition to Absolute Total Care? You can file your appeal by calling or writing to us. These grievances may be about: The state of South Carolina allows members to file a grievance at anytime from the event that caused the dissatisfaction. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` This manual sets forth the policies and procedures that providers participating in the Absolute Total Carenetwork are required tofollow. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Learn more about how were supporting members and providers. Professional and Institutional Fee-For-Service EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 14163. To continue care with their current provider after the 90-day transition of care, the provider must agree to work with Absolute Total Care on the member's care and accept Absolute Total Care's payment rates. To do this: We expect this process to be seamless for our valued members, and there will be no break in their coverage. A. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. S< Box 31224 Claims Department Example of how to properly split claim that span the cutover date of April 1, 2021: Q. 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. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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. Symptoms are flu-like, including: Fever Coughing Welcome to Wellcare By Allwell, a Medicare Advantage plan. You can file the grievance yourself. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. The provider needs to contact Absolute Total Care to arrange continuing care. A grievance is when you tell us about a concern you have with our plan. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Columbia, SC 29202-8206. 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. Please contact our Provider Services Call Center at 1-888-898-7969. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. WellCare is the health care plan that puts you in control. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. Q. 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. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. To earn rewards, members must: Download the Go365 for Humana Healthy Horizons app onto a mobile device from the Apple App Store or Google Play. A. If you need claim filing assistance, please contact your provider advocate. 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 annual flu vaccine helps prevent the flu.Protect yourself and those around you. Will Absolute Total Care change its name to WellCare? We try to make filing claims with us as easy as possible. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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. 837 Institutional Encounter 5010v Guide Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. You and the person you choose to represent you must sign the AOR form. You and the person you choose to represent you must sign the AOR statement. You may file your second level grievance review within 30 days of receiving your grievance decision letter. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. It was a smart move. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Or it can be made if we take too long to make a care decision. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. We are glad you joined our family! Tampa, FL 33631-3384. Q. P.O. 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. Welcome to WellCare Provider Login Contact Us Join Our Network Medicaid Medicare Tools News and Education AcariaHealth Specialty Pharmacy Pharmacy Forms Request for Drug Coverage Request to Review Drug Coverage Denial . Members will receive a 90-day transition of care period if the member is receiving ongoing care and treatment. If you think you might have been exposed, contact a doctor immediately. * Username. Q. 0 Finding a doctor is quick and easy. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Reminder: It is important that providers check eligibility prior to providing services as members can potentially change plans prior to April 1, 2021 if they are in the annual choice period. A. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. A. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. The member will be encouraged to establish care with a new in network primary care provider/specialist prior to the end of the transition/continuity of care period to review present treatment plan and coordinate the member's medical care. 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. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. Instructions on how to submit a corrected or voided claim. We understand that maintaining a healthy community starts with providing care to those who need it most. Absolute Total Care Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. The hearing officer does not decide in your favor. Within five business days of getting your grievance, we will mail you a letter. 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. We will do this as quickly as possible as but no longer than 72-hours from the decision. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Wellcare uses cookies. We would like to help your billing department get your EDI (claims and real time) transactions processed as efficiently as possible. Explains how to receive, load and send 834 EDI files for member information. Ambetter from Absolute Total Care - South Carolina. WellCare Medicare members are not affected by this change. A. 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. How do I join Absolute Total Cares provider network? 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. For example, if a payer has a 90-day timely filing requirement, that means you need to submit the claim within 90 days of the date of service. Q. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. 1,flQ*!WLOmsmz\D;I5BI,yA#z!vYQi5'fedREF40 b666q1(UtUJJ.i` (T/@E 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. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Q. We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Living Well Quality of Care Medicaid Managed Care Medicaid and CHIP Quality Resource Library Improvement Initiatives Performance Measurement Releases & Announcements Enrollment Strategies Continuous Eligibility Express Lane Eligibility Lawfully Residing Immigrant Children & Pregnant Women Presumptive Eligibility Home & Community Based Services Q. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Your second-level review will be performed by person(s) not involved in the first review. 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. Beginning. P.O. We expect this process to be seamless for our valued members and there will be no break in their coverage. Box 31224 Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . 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. A provider can act for a member in hearings with the member's written permission in advance. 2023 Medicare and PDP Compare Plans and Enroll Now. We will send you another letter with our decision within 90 days or sooner. We expect this process to be seamless for our valued members and there will be no break in their coverage.
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