you have another option. N .7$* P!70 *I;Rox3 ] LS~. Please be sure to use the correct line of business prior authorization form for prior authorization requests. It is called a "Notice of Adverse Benefit Determination" or "NABD." 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. Box 3050 %%EOF What will happen to unresolved claims prior to the membership transfer? To do so by phone, call Member Services at 1-888-588-9842 (TTY1-877-247-6272). Explains how to receive, load and send 834 EDI files for member information. A. We want you to let us know right away if you have any questions, grievances or problems with your covered services or the care you receive. Outpatient Prior Authorization Form (PDF) Inpatient Prior Authorization Form (PDF) S< With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. Absolute Total Care 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. Will Absolute Total Care continue to offer Medicare and Marketplace products? You must ask within 30 calendar days of getting our decision. Addakam ditoy para kenka. If you file a grievance or an appeal, we must be fair. Wellcare uses cookies. This gives members time to establish with a new provider in the network and ensure that they have continuity of care. Box 6000 Greenville, SC 29606. The onlineProvider Manual represents the most up-to-date information on Absolute Total Cares Medicaid Plan, programs, policies, and procedures. As of April 1, 2021, WellCare will no longer be a separate plan option offered by South Carolina Healthy Connections Choices. For the latest COVID-19 news, visit the CDC. If you need claim filing assistance, please contact your provider advocate. Claims for services on or after April 1, 2021 should be filed to Absolute Total Care for processing. Please use the From Date Institutional Statement Date. 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 Pharmacy services prior to 4/1/2021 must be requested from WellCare South Carolina. Q. This person has all beneficiary rights and responsibilities during the appeal process. Copyright 2023 Wellcare Health Plans, Inc. 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. 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. Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions. Members can continue to receive services from their current WellCare provider as long as they remain covered under WellCare. We process check runs daily, with the exception of Sundays, National Holidays, and the last day of the month. 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. Box 100605 Columbia, SC 29260. 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. Providers interested in joining the Absolute Total Care Provider Network should submit a request to Network Development and Contracting via email at. To do this: Be sure to ask us to continue your benefits within the 10 calendar day time frame. Farmington, MO 63640-3821. Box 31384 P.O. If Statement Range is April 2, 2021 through April 10, 2021, please send to Absolute Total Care. Kasapulam ti tulong? Copyright 2023 Wellcare Health Plans, Inc. Clinical Laboratory Improvement Amendments (CLIA). 1044 0 obj <> endobj Those who attend the hearing include: You can also request to have your hearing over the phone. Synagis (RSV) - Medical Benefit or Retail Pharmacy, 17P or Makena - Medical Benefit or Retail Pharmacy, Special Supplemental Benefits for Chronically Ill (SSBCI), Screening, Brief Intervention, and Referral to Treatment (SBIRT), Patient Centered Medical Home Model (PCMH), Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance (NCQA), Hurricane Florence: What You Need to Know, Absolute Total Care Payment Policy and Edit Updates Effective 5/1/21, Notice About a New Payment Integrity Audit Program, Absolute Total Care Updated Guidance for Medicaid BabyNet Therapy Providers, Wellcare By Allwell Changing Peer-to-Peer Review Request and Elective Inpatient Prior Authorization Requirements for Medicare Advantage Plans, NEW Attestation Process for Special Supplemental Benefits for Chronically Ill (SSBCI), Medicare Prior Authorization Change Summary - Effective 1/1/2023. We try to make filing claims with us as easy as possible. A provider can act for a member in hearings with the member's written permission in advance. Ancillary Claims Filing Reminders; ClaimsXten TM: Correct Coding Initiative Reference Guide; Inpatient Non-Reimbursable Charges/Unbundling Policy Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 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 By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Shop or Enroll in a Plan Frequently Asked Questions Find a Doctor Download Digital ID Card Welcome Allwell Members! %PDF-1.6 % For additional information, questions or concerns, please contact your local Provider Network Management Representative. If an authorization is needed, you can log in to the Secure Provider Portal at absolutetotalcare.com to submit and confirm authorizations. 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. 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 . We encourage you to check the Medicaid Pre-Auth Check Toolto ensure that you are accessing the most current Absolute Total Care authorization requirements for dates of service on or after April 1, 2021. 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. The annual flu vaccine helps prevent the flu.Protect yourself and those around you. 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? 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're here for you. You or your provider must call or fax us to ask for a fast appeal. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. Ambetter Timely Filing Limit of : 1) Initial Claims. \{-w{,xI202100$0*bZf ,X AayhP3pYla" e 3G& `eoT#@ *;d (This includes your PCP or another provider.) You or your authorized representative will tell the hearing officer why you think we made the wrong decision. South Carolina | Wellcare SOUTH CAROLINA Healthcare done well. These materials are for informational purposes only. Additionally, WellCare will have a migration section on their provider page at publishing FAQs. Will Absolute Total Care change its name to WellCare? Examples: If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. 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. 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? WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. Symptoms are flu-like, including: Fever Coughing Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. B^E{h#XYQv;[ny3Hha1yx4v.sBy jWacQzyL.kHhwtQ~35!Rh#)p+sj31LcC)4*Z:IWIG@WTD- )n,! The participating provider agreement with WellCare will remain in-place after April 1, 2021. April 1-April 3, 2021, please send to Absolute Total Care. There is a lot of insurance that follows different time frames for claim submission. People of all ages can be infected. WellCare Medicare members are not affected by this change. WellCare of North Carolina will begin to release medical payments to providers beginning July 6, 2021. It will tell you we received your grievance. 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. endstream endobj startxref We may apply a 14 day extension to your grievance resolution. PROVIDERS NOTE:Please send Corrected Claims as normal submissions via electronic or paper. WellCare claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. You can file a grievance by calling or writing to us. A. Know the facts about Coronavirus (COVID-19) Our call centers, including the nurse advice line, are currently experiencing high volume. If Statement Range is March 14, 2021 through April 3, 2021, please send to WellCare. Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions. 0 Your second-level review will be performed by person(s) not involved in the first review. Date of Occurrence/DOSprior toApril 1, 2021: Processed by WellCare. The provider needs to contact Absolute Total Care to arrange continuing care. The state has also helped to set the rules for making a grievance. ?-}++lz;.0U(_I]:3O'~3-~%-JM Earliest From Dates prior to April 1, 2021 should be filed to WellCare of South Carolina. 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. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. The annual flu vaccine helps prevent the flu. The Medicare portion of the agreement will continue to function in its entirety as applicable. WellCare Medicare Advantage Claims must be filed within 180 calendar days from the date of service. For current information, visit the Absolute Total Care website. 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. 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). Q. Columbia, SC 29202-8206. Electronic and Paper Claims Submissions; Institutional Claims/Encounter Guides. 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. Wfu neebybfgnh bgWfulnybfgC South Carolina Medicaid Provider Resource Guide Thank you for being a star member of our provider team. Overview & Resources WellCare of North Carolina partners with providers to develop and deliver high-quality, cost-effective health care solutions. A. The Medicare portion of the agreement will continue to function in its entirety as applicable. WellCare and Absolute Total Care Medicare plans will continue to operate under current brands, product names and provider contracts, until further notice. #~0 I WellCare is the health care plan that puts you in control. It was a smart move. Refer to your particular provider type program chapter for clarification. 8h} \x p`03 1z`@+`~70 G ~Ws5Puick79,4 ,O5@?O-Gr'|5Oj:v6/` With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. BlueCross BlueShield of South Carolina Piedmont Service Center P.O. From Date Institutional Statement Dates on or after 4/1/2021 should be filed to Absolute Total Care. That's why we provide tools and resources to help. WellCare has partnered with Change Healthcare as our preferred EDI Clearinghouse. DOSApril 1, 2021 and after: Processed by Absolute Total Care. Coronavirus Disease 2019 (COVID-19) causes respiratory illness in people and can spread from person to person. We expect this process to be seamless for our valued members, and there will be no break in their coverage. 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. Medicaid Claims Payment Policies WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. 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. You can also have a video visit with a doctor using your phone or computer. We must have your written permission before someone can file a grievance for you. Please contact our Provider Services Call Center at 1-888-898-7969. If you request a hearing, the request must: A State Fair Hearing is a legal proceeding. WellCare Medicare members are not affected by this change. We understand that maintaining a healthy community starts with providing care to those who need it most. You can file an appeal if you do not agree with our decision. Our toll-free fax number is 1-877-297-3112. The hearing officer does not decide in your favor. You can file your appeal by calling or writing to us. Payments mailed to providers are subject to USPS mailing timeframes. We will send you another letter with our decision within 90 days or sooner. Hearings are used when you were denied a service or only part of the service was approved. 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. A. 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. pst/!+ Y^Ynwb7tw,eI^ Reconsideration or Claim Disputes/Appeals: Tampa, FL 33631-3372. You can do this at any time during your appeal. All dates of service on or after April 1, 2021 should be filed to Absolute Total Care. 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. Provider can't require members to appoint them as a condition of getting services. More Information Need help? Our fax number is 1-866-201-0657. 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. Register now at https://www.payspanhealth.comor contact PaySpan at providersupport@payspanhealth.com, or 877-331-7154. 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. 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. Resources 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. Where should I submit claims for WellCare Medicaid members? You will need Adobe Reader to open PDFs on this site. To avoid rejections please split the services into two separate claim submissions. We will review it and send you a decision letter within 30 calendar days from receiving your appeal. Providers are encouraged to sign up to receive EFT payments to avoid any payment delays. The second level review will follow the same process and procedure outlined for the initial review. For general questions about claims submissions, call Provider Claims Services at 1-800-575-0418. P.O. Finding a doctor is quick and easy. APPEALS, GRIEVANCES AND PROVIDER DISPUTES. 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. 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 You will have a limited time to submit additional information for a fast appeal. Wellcare uses cookies. 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 help facilitate timely claim payment by having an understanding of our processes and requirements. 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. 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. Absolute Total Care will utilize credentialing cycles from WellCare and Absolute Total Care so that providers will only need to credential once every three years. Absolute Total Care will continue to offer Marketplace products under the Ambetter brand. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. Timely filing limits vary. 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. Need an account? We will also send you a letter with our decision within 72 hours from receiving your appeal. We are proud to announce that WellCare is now part of the Centene Family. 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. Member Sign-In. A. Initial Claims: 120 Days from the Date of Service. We expect this process to be seamless for our valued members and there will be no break in their coverage. An authorized representative is someone you select to act on the behalf of a member to assist them through the appeals process. 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. Claims will be processed according to timely filing provisions in the providers Absolute Total Care Participating Provider Agreement. DOS prior to April 1, 2021: Processed by WellCare. Please use the From Date Institutional Statement Date. With the completion of this transaction, we have created a premier healthcare enterprise focused on government-sponsored healthcare programs. An appeal is a request you can make when you do not agree with a decision we made about your care. Ambetter from Absolute Total Care - South Carolina. 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. WellCare of South Carolina will be known as Absolute Total Care as of April 1, 2021. 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. Or you can have someone file it for you. 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. Box 3050 Additionally, WellCare will have a migration section on their provider webpage publishing FAQs. We are glad you joined our family! Instructions on how to submit a corrected or voided claim. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. You, your friend, a relative, legal counsel or other spokesperson who has your written consent may ask for a State Fair Hearing. 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. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health. However, there will be no members accessing/assigned to the Medicaid portion of the agreement. Keep yourself informed about Coronavirus (COVID-19.) Claims will be processed according to timely filing provisions in the providers WellCare Participating Provider Agreement. 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. 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 Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 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. We cannot disenroll you from our plan or treat you differently. With quality healthcare solutions, Ambetter from Absolute Total Care helps residents of South Carolina live better. How do I determine if an institutional inpatient bill type submission overlapping 4/1/2021 should be filed to WellCare or Absolute Total Care? Q. Q. Please Explore the Site and Get To Know Us. What is the Rx BIN and Group Number for WellCare members transitioning to Absolute Total Care on April 1, 2021? A. What will happen to my Participating Provider Agreement with WellCare after 4/1/2021? Instructions on how to submit a corrected or voided claim. All dates of service on or after 4/1/2021 should be filed to Absolute Total Care. As of April 1, 2021, all WellCare of South Carolina Medicaid members will become Absolute Total Care members. 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.