Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. We try to make filing claims with us as easy as possible. How will credentialing/recredentialing be handled by Absolute Total Care if a provider was recently credentialed/recredentialed by WellCare? We expect this process to be seamless for our valued members and there will be no break in their coverage. 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 Welcome to Wellcare By Allwell, a Medicare Advantage plan. Forms. Will Absolute Total Care continue to offer Medicare and Marketplace products? 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. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. 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. Date of Occurrence/DOSApril 1, 2021 and after: Processed by Absolute Total Care. Payments mailed to providers are subject to USPS mailing timeframes. All dates of service prior to 4/1/2021 should be filed to WellCare of South Carolina. A. Q. If you wish to use a representative, then he or she must complete an Appointment of Representative (AOR) statement. You can ask for a State Fair Hearing after we make our appeal decision. 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? Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. A. Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Get an annual flu shot today. We cannot disenroll you from our plan or treat you differently. You may file your second level grievance review within 30 days of receiving your grievance decision letter. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Wellcare uses cookies. 1096 0 obj
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At the hearing, well explain why we made our decision. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. We are glad you joined our family! 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. We encourage you to check the Medicaid Pre-Auth Check Tool in the For Providers section on the Absolute Total Care website at absolutetotalcare.com to ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after 4/1/2021. %PDF-1.6
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Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. You can get many of your Coronavirus-related questions answered here. April 1-April 3, 2021, please send to Absolute Total Care. Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. 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. As of April 1, 2021 Absolute Total Care, a Centene company, is now the health plan for South Carolina Medicaid members. Member Appeals (Medical, Behavioral Health, and Pharmacy): You will need Adobe Reader to open PDFs on this site. A grievance is when you tell us about a concern you have with our plan. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. We will continue covering your medical services during your appeal request and State Fair Hearing if all of the following are meet. If an authorization is needed, you can log in to the Secure Provider Portalto submit and confirm authorizations. Need an account? Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 Farmington, MO 63640-3821. The hearing officer does not decide in your favor. 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. Q. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. Written notice is not needed if your expedited appeal request is filed verbally. Register now at https://www.payspanhealth.comor contact PaySpan at
[email protected], or 877-331-7154. Please see list of services that will require authorization during this time. We will call you with our decision if we decide you need a fast appeal. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. There is a lot of insurance that follows different time frames for claim submission. A. S< BlueCross BlueShield of South Carolina Piedmont Service Center P.O. A. You can file your appeal by calling or writing to us. 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. z4M0(th`1Lf`M18c BIcJ[%4l JU2 _
s Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. We are committed to improving the quality of life of our millions of members, who often include some of our nations most vulnerable populations. Members will need to talk to their provider right away if they want to keep seeing him/her. the timely filing limits due to the provider being unaware of a beneficiary's coverage. Q. 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. You can file an appeal if you do not agree with our decision. Your second-level review will be performed by person(s) not involved in the first review. A. 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. Additionally, WellCare will have a migration section on their provider page at
publishing FAQs. 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. WellCare is the health care plan that puts you in control. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 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. Refer to your particular provider type program chapter for clarification. Columbia, SC 29202-8206. March 14-March 31, 2021, please send to WellCare. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. Reconsideration or Claim Disputes/Appeals: To do this: \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d
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. Q. How do I join Absolute Total Cares provider network? 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. We expect this process to be seamless for our valued members and there will be no break in their coverage. 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. A. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. 941w*)bF
iLK\c;nF mhk} Always verify timely filing requirements with the third party payor. DOS April 1, 2021 and after: Processed by Absolute Total Care. 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. Instructions on how to submit a corrected or voided claim. If you need claim filing assistance, please contact your provider advocate. WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. 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. Q. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. 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, 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. Claims Department Ambetter Timely Filing Limit of : 1) Initial Claims. Wellcare uses cookies. 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. pst/!+ Y^Ynwb7tw,eI^ 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. DOS prior to April 1, 2021: Processed by WellCare. 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. Member Sign-In. 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. Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. You can file a grievance by calling or writing to us. 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. Will WellCare continue to offer current products or Medicare only? WellCare Medicare members are not affected by this change. They must inform their vendor of AmeriHealth Caritas . You or your authorized representative can review the information we used to make our decision. endstream
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hbbd``b`$= $ A provider can act for a member in hearings with the member's written permission in advance. Wellcare uses cookies. Send your written appeal to: We must have your written consent before someone can file an appeal for you. You will have a limited time to submit additional information for a fast appeal. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. The state has also helped to set the rules for making a grievance. We're here for you. 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. Learn how you can help keep yourself and others healthy. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Download the free version of Adobe Reader. You can ask in writing for a State Fair Hearing (hearing, for short). A. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. * Username. Tampa, FL 33631-3372. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. A. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy No, Absolute Total Care will continue to operate under the Absolute Total Care name. Example of how to properly split claim that span the cutover date of April 1, 2021: Q. Search for primary care providers, hospitals, pharmacies, and more! Example of how to properly split claim that span the cutover date of April 1, 2021: Yes, Absolute Total Care and WellCare will continue to offer Medicare products under their current brands and product names, until further notice. We must have your written permission before someone can file a grievance for you. 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 Providers can begin requesting prior authorization from Absolute Total Care for dates of service on or after April 1, 2021 from Absolute Total Care on March 15, 2021. A. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Please use the From Date Institutional Statement Date. An appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. Box 31224 Q: What is Absolute Total Cares Transition/Continuity of Care Policy? Obstetrician care provided by an out of network Obstetrician will be covered for pregnant members inclusive of post-partum care. Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Box 3050 Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. Providers are encouraged to visit the Provider Resources webpagefor manuals, forms, and resources related to claims submission, eligibility, prior authorization, and more. You may request a State Fair Hearing at this address: South Carolina Department of Health 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Those who attend the hearing include: You can also request to have your hearing over the phone. Register now at https://www.payspanhealth.com or contact PaySpan at [email protected], or 877-331-7154. Box 600601 Columbia, SC 29260. The participating provider agreement with WellCare will remain in-place after 4/1/2021. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. 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. 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. 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. Call us to get this form. In this section, we will explain how you can tell us about these concerns/grievances. 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. 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. WellCare Medicare members are not affected by this change. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Awagandakami An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. Box 31384 We will also send you a letter with our decision within 72 hours from receiving your appeal. 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. A. Box 8206 Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. The provider needs to contact Absolute Total Care to arrange continuing care. 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. 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? Timely Filing Limits for all Insurances updated (2023) - Bcbsproviderphonenumber Timely Filing Limits for all Insurances updated (2023) One of the common and popular denials is passed the timely filing limit. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. A. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. More Information Need help? First Choice can accept claim submissions via paper or electronically (EDI). With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. 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. 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. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. Explains how to receive, load and send 834 EDI files for member information. North Carolina PHP Billing Guidance for Local W Code. Explains how to receive, load and send 834 EDI files for member information. Register now. No, Absolute Total Care will continue to operate under the Absolute Total Care name. L]4(f4/pn~YTZSp-5/O*F)e~p:a6o{x8r Payments mailed to providers are subject to USPS mailing timeframes. However, as of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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. 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. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Finding a doctor is quick and easy. If you are unable to view PDFs, please download Adobe Reader. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. Q. 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. If you file a grievance or an appeal, we must be fair. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . N .7$* P!70 *I;Rox3
] LS~. For dates of service on or after April 1, 2021: Absolute Total Care You can get many of your Coronavirus-related questions answered here. We expect this process to be seamless for our valued members, and there will be no break in their coverage. The onlineProvider Manual represents the most up-to-date information on Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan), programs, policies, and procedures. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. 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. That's why we provide tools and resources to help. This manual sets forth the policies and procedures that providers participating in the Wellcare Prime network are required to follow. Within five business days of getting your grievance, we will mail you a letter. Keep yourself informed about Coronavirus (COVID-19.) Q. Attn: Grievance Department * Password. 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. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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. When you receive your notification of WellCares grievance resolution, and you are dissatisfied with the resolution regarding adverse decisions that affect your ability to receive benefits, access to care, access to services or payment for care of services, you may request a second level review with WellCare. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. 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. hb```b``6``e`~ "@1V
NB, The rules include what we must do when we get a grievance. $8v + Yu @bAD`K@8m.`:DPeV @l 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. Tampa, FL 33631-3372. 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. Q. ?-}++lz;.0U(_I]:3O'~3-~%-JM You may do this in writing or in person. Our health insurance programs are committed to transforming the health of the community one individual at a time. Will my existing WellCare patients be assigned to my Absolute Total Care Panel? We will do this as quickly as possible as but no longer than 72-hours from the decision.
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