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Need an account? 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. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! 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. All Paper Claim Submissions can be mailed to: WellCare Health Plans An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. South Carolina Department of Health and Human Services Division of Appeals and Hearings P.O. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. Claim Filing Manual - First Choice by Select Health of South Carolina More Information Coronavirus (COVID-19) 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. Professional and Institutional Encounter EDI transactions should be submitted to WellCare of South Carolina Medicaid with Payer ID 59354. 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 Attn: Grievance Department Written notice is not needed if your expedited appeal request is filed verbally. We will send you another letter with our decision within 90 days or sooner. These materials are for informational purposes only. We try to make filing claims with us as easy as possible. The state has also helped to set the rules for making a grievance. To do this: UHC Community TFL - Timely filing Limit: 120 Days: Unitedhealthcare TFL - Timely filing Limit: Participating Providers: 90 days Non Participating Providers: 180 Days If its secondary payer: 90 days from date of Primary Explanation of Benefits Unitedhealthcare timely filing limit for appeals: 12 months from original claim determination Or it can be made if we take too long to make a care decision. 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. You will get a letter from us when any of these actions occur. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Providers do not need to do anything additional to provide services on or after April 1, 2021 if the provider is in network with both WellCare and Absolute Total Care. 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. You or your authorized representative will tell the hearing officer why you think we made the wrong decision. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. You may do this in writing or in person. 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? 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. Tampa, FL 33631-3372. 2023 Medicare and PDP Compare Plans and Enroll Now. That's why we provide tools and resources to help. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. 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). Our fax number is 1-866-201-0657. If you think you might have been exposed, contact a doctor immediately. Register now. DOSApril 1, 2021 and after: Processed by Absolute Total Care. 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. 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 Resources 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. Learn how you can help keep yourself and others healthy. It will tell you we received your grievance. 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. We are proud to announce that WellCare is now part of the Centene Family. 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. We expect this process to be seamless for our valued members, and there will be no break in their coverage. P.O. Instructions on how to submit a corrected or voided claim. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Claims Submission, Correspondence and Contact Resources will stay the same for the Medicare line of business. You may file your second level grievance review within 30 days of receiving your grievance decision letter. You can file an appeal if you do not agree with our decision. We will also send you a letter with our decision within 72 hours from receiving your appeal. Providers interested in joining the Absolute Total Care vision network for routine vision services can contact Envolve Vision at 1-800-531-2818. WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Stay informed - activate your online account Behavioral Health Crisis Line 844-594-5076 (TTY 711) 24 hours a day, seven days a week Call us if you are experiencing emotional or mental pain or distress. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. A. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Payments mailed to providers are subject to USPS mailing timeframes. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. Wellcare uses cookies. A. Learn more about how were supporting members and providers. pst/!+ Y^Ynwb7tw,eI^ Q: What is Absolute Total Cares Transition/Continuity of Care Policy? To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). To write us, send mail to: You can fax it too. As of April 1, 2021, all WellCare of South Carolina Medicaid members will transfer to Absolute Total Care. Provider can't require members to appoint them as a condition of getting services. If you need assistance with your appeal please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your appeal. 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. 0 However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Please use WellCare Payor ID 14163. Wellcare uses cookies. State Health Plan State Claims P.O. Claims for services prior to April 1, 2021 should be filed to WellCare for processing. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. 3) Coordination of Benefits. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. A. Box 100605 Columbia, SC 29260. The Claim Reconsideration process is an informal claim review, and is not a substitute for an appeal of a final agency decision. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. You will need Adobe Reader to open PDFs on this site. At WellCare, we value everything you do to deliver quality care to our members your patients and ensure they have a positive health care experience. 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. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. P.O. Please use the Earliest From Date. 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. Box 8206 Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Reconsideration or Claim Disputes/Appeals: Q. Contact Wellcare Prime Provider Service at1-855-735-4398if youhave questions. Box 31224 WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. Awagandakami WellCare credentialing cycles will be shared with Absolute Total Care in order to reduce duplicative credentialing in the future. This person has all beneficiary rights and responsibilities during the appeal process. Thanka kaa yoa Tufrbeau ingsnh ngetfu South Caralaita nouMa mpvd. Members will need to talk to their provider right away if they want to keep seeing him/her. March 14-March 31, 2021, please send to WellCare. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments. 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. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. Beginning. 941w*)bF iLK\c;nF mhk} Wellcare wants to ensure that claims are handled as efficiently as possible. P.O. 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. Copyright 2023 Wellcare Health Plans, Inc. Tampa, FL 33631-3384. Please use the From Date Institutional Statement Date. endstream endobj startxref Wellcare uses cookies. 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. 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. Welcome to WellCare of South Carolina! No, Absolute Total Care will continue to operate under the Absolute Total Care name. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. 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. 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. Earliest From Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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. The participating provider agreement with WellCare will remain in-place after 4/1/2021. The Medicare portion of the agreement will continue to function in its entirety as applicable. 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. 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. We are proud to announce that WellCare is now part of the Centene Family. For standard requests, if you call in your appeal, you must follow up with a written, signed one, within thirty calendar days. P.O. 2) Reconsideration or Claim disputes/Appeals. 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. Medicaid Claims Payment Policies If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. North Carolina PHP Billing Guidance for Local W Code. 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. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. You can ask for a State Fair Hearing after we make our appeal decision. 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. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. Q. Box 8206 Columbia, SC 29202-8206 Or call 1-800-763-9087. Want to receive your payments faster to improve cash flow? With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. Instructions on how to submit a corrected or voided claim. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. 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. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. From Date Institutional Statement Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. South Carolina DEPARTMENT OF HEALTH AND HUMAN SERVICES Post Office Box 8206 Columbia, South Carolina 29202-8206 www.scdhhs.gov November 24, 2009 ALL . Those who attend the hearing include: You can also request to have your hearing over the phone. #~0 I Effective January 1, 2015 the South Carolina Department of Health and Human Services (SCDHHS) will implement a Claim Reconsideration Policy. Claim Filing AmeriHealth Caritas North Carolina, hereafter referred to as the Plan (where appropriate), is required by the North Carolina and federal regulations to capture specific data regarding services rendered to its members. Q. To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). 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 . We have licensed clinicians available to speak with you and to connect you to the support you need to feel better. Only you or your authorizedrepresentative can ask for a State Fair Hearing. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. 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. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. From Date Institutional Statement Dates on or after April 1, 2021 should be filed to Absolute Total Care. 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 Register now at https://www.payspanhealth.com or contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. Absolute Total Care will honor all existing WellCare authorization approvals that include dates of service beyond March 31, 2021. Where should I submit claims for WellCare Medicaid members? There is a lot of insurance that follows different time frames for claim submission. 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. The Medicare portion of the agreement will continue to function in its entirety as applicable. Exceptions to the one-year time limit: a) Medicare Cost Sharing Claims . A. In South Carolina, WellCare and Absolute Total Care are joining to better serve you. Earliest From Dates on or after 4/1/2021 should be filed to Absolute Total Care. Can I continue to see my current WellCare members? Tampa, FL 33631-3372. Contact Absolute Total Care Provider Service at1-866-433-6041if youhave questions. Ambetter Timely Filing Limit of : 1) Initial Claims. %%EOF You can file a grievance by calling or writing to us. 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. A. 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. 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). We understand that maintaining a healthy community starts with providing care to those who need it most. You can get many of your Coronavirus-related questions answered here. 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. The participating provider agreement with WellCare will remain in-place after 4/1/2021. You or your authorized representative can review the information we used to make our decision. 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. Members will need to talk to their provider right away if they want to keep seeing him/her. You and the person you choose to represent you must sign the AOR statement. Absolute Total Care will honor those authorizations. Ambetter from Absolute Total Care - South Carolina. Pharmacy services prior to April 1, 2021 must be requested from WellCare of South Carolina. 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. Claims submission, correspondence, and contact resources will stay the same for the Medicare line of business. All dates of service prior to April 1, 2021 should be filed to WellCare of South Carolina. WellCare is the health care plan that puts you in control. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Obstetrician care provided by an out-of-network obstetrician will be covered for pregnant members inclusive of postpartum care. S< A. An appeal is a request you can make when you do not agree with a decision we made about your care. Explains how to receive, load and send 834 EDI files for member information. WellCare Medicare members are not affected by this change. Will Absolute Total Care continue to offer Medicare and Marketplace products? Members must have Medicaid to enroll. You can make three types of grievances. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. 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. If you need claim filing assistance, please contact your provider advocate. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Earliest From Dates prior to 4/1/2021 should be filed to WellCare of South Carolina. (This includes your PCP or another provider.) WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. All billing requirements must be adher ed to by the provider in order to ensure timely processing of claims. The provider needs to contact Absolute Total Care to arrange continuing care. you have another option. Your second-level review will be performed by person(s) not involved in the first review. Search for primary care providers, hospitals, pharmacies, and more! Incorrect forms will not be considered and may lead to further delays in processing prior authorization requests. We welcome Brokers who share our commitment to compliance and member satisfaction. Farmington, MO 63640-3821. 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. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. For example, if any patient gets services on the 1st of any month then there is a time limit to submit his/her claim to the insurance company for reimbursement.